Podocytopathy in patients with monoclonal gammopathy: three patients and literature review.
MGRS
Wäldestrom disease
focal segmental glomerulosclerosis
minimal change disease
multiple myeloma
podocytopathy
Journal
Clinical kidney journal
ISSN: 2048-8505
Titre abrégé: Clin Kidney J
Pays: England
ID NLM: 101579321
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
received:
21
04
2021
entrez:
25
2
2022
pubmed:
26
2
2022
medline:
26
2
2022
Statut:
epublish
Résumé
Renal manifestations of monoclonal gammopathies are of increasing interest among nephrologists. Typical manifestations include light chain cast nephropathy, amyloidosis or renal damage mediated by monoclonal immunoglobulin deposition. Podocytopathies in the setting of an underlying monoclonal gammopathy constitute a rare manifestation of these diseases and, although being described in the literature, remain a challenge since most data derive from case reports. A retrospective review of the clinical data of Hospital del Mar and Hospital Vall d'Hebron was performed to identify patients with minimal change disease (MCD) or focal and segmental glomerulosclerosis (FSGS) in the setting of neoplasms that produce monoclonal (M) protein. Additionally, a literature review on this topic was performed. This study aims to describe the clinical characteristics and outcomes of these patients. Three patients were identified to have podocytopathy and monoclonal gammopathy between the years 2013 and 2020. All three were males and >65 years of age. Two patients were diagnosed with MCD and one patient was diagnosed with FSGS. All patients underwent a kidney biopsy and light and electron microscopic studies were performed. The underlying causes of monoclonal gammopathy were multiple myeloma in two cases and Waldeström macroglobulinemia in one case. Two patients developed nephrotic syndrome during the follow-up. All patients were under active hematological treatment. One patient presented a complete remission of proteinuria whereas the other two presented a partial remission. Podocytopathies may infrequently be found in patients with monoclonal gammopathies. Patients with overt glomerular proteinuria and hematological disorders with M protein should undergo a kidney biopsy for prompt diagnosis and to specify a prognosis. In addition, further study on this matter must be done to understand the pathophysiology and treat these patients appropriately.
Sections du résumé
BACKGROUND
BACKGROUND
Renal manifestations of monoclonal gammopathies are of increasing interest among nephrologists. Typical manifestations include light chain cast nephropathy, amyloidosis or renal damage mediated by monoclonal immunoglobulin deposition. Podocytopathies in the setting of an underlying monoclonal gammopathy constitute a rare manifestation of these diseases and, although being described in the literature, remain a challenge since most data derive from case reports.
METHODS
METHODS
A retrospective review of the clinical data of Hospital del Mar and Hospital Vall d'Hebron was performed to identify patients with minimal change disease (MCD) or focal and segmental glomerulosclerosis (FSGS) in the setting of neoplasms that produce monoclonal (M) protein. Additionally, a literature review on this topic was performed. This study aims to describe the clinical characteristics and outcomes of these patients.
RESULTS
RESULTS
Three patients were identified to have podocytopathy and monoclonal gammopathy between the years 2013 and 2020. All three were males and >65 years of age. Two patients were diagnosed with MCD and one patient was diagnosed with FSGS. All patients underwent a kidney biopsy and light and electron microscopic studies were performed. The underlying causes of monoclonal gammopathy were multiple myeloma in two cases and Waldeström macroglobulinemia in one case. Two patients developed nephrotic syndrome during the follow-up. All patients were under active hematological treatment. One patient presented a complete remission of proteinuria whereas the other two presented a partial remission.
CONCLUSIONS
CONCLUSIONS
Podocytopathies may infrequently be found in patients with monoclonal gammopathies. Patients with overt glomerular proteinuria and hematological disorders with M protein should undergo a kidney biopsy for prompt diagnosis and to specify a prognosis. In addition, further study on this matter must be done to understand the pathophysiology and treat these patients appropriately.
Identifiants
pubmed: 35211301
doi: 10.1093/ckj/sfab176
pii: sfab176
pmc: PMC8862048
doi:
Types de publication
Journal Article
Langues
eng
Pagination
417-424Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the ERA.
Références
Am J Kidney Dis. 2003 Nov;42(5):1097-101
pubmed: 14582054
Ren Fail. 2014 Feb;36(1):114-8
pubmed: 24059636
Lancet Oncol. 2014 Nov;15(12):e538-48
pubmed: 25439696
Nat Rev Nephrol. 2016 Dec;12(12):768-776
pubmed: 27748392
Clin Sci (Lond). 2004 Aug;107(2):125-36
pubmed: 15157184
Clin J Am Soc Nephrol. 2017 Feb 7;12(2):332-345
pubmed: 27940460
Case Rep Nephrol. 2020 Aug 27;2020:8895705
pubmed: 32908739
Am J Nephrol. 2018;47 Suppl 1:3-13
pubmed: 29852492
Clin J Am Soc Nephrol. 2018 Jan 6;13(1):128-139
pubmed: 29114004
Curr Opin Nephrol Hypertens. 2016 Mar;25(2):127-37
pubmed: 26735145
Nat Rev Nephrol. 2019 Jan;15(1):45-59
pubmed: 30510265
Clin Chem Lab Med. 2007;45(2):190-6
pubmed: 17311507
World J Clin Cases. 2019 Aug 26;7(16):2393-2400
pubmed: 31531336
Clin J Am Soc Nephrol. 2017 Mar 7;12(3):502-517
pubmed: 28242845
Front Med (Lausanne). 2018 Jun 11;5:170
pubmed: 29942802
N Engl J Med. 1978 Apr 13;298(15):826-33
pubmed: 634317
Medicine (Baltimore). 2018 Dec;97(52):e13638
pubmed: 30593133
Br J Haematol. 2003 Jun;121(5):749-57
pubmed: 12780789
Am J Kidney Dis. 2004 Feb;43(2):e10-2
pubmed: 14750118
J Clin Med Res. 2013 Dec;5(6):481-3
pubmed: 24171061
Medicine (Baltimore). 2014 Nov;93(24):350-358
pubmed: 25500704
Am J Case Rep. 2018 Aug 13;19:946-950
pubmed: 30100602
PLoS One. 2019 Apr 2;14(4):e0214614
pubmed: 30939176
Am J Kidney Dis. 2005 Aug;46(2):278-82
pubmed: 16112046
Proc (Bayl Univ Med Cent). 2014 Jan;27(1):19-21
pubmed: 24381395