S WILKINSON1, S VENUTHURUPALLI1,2,3, A CAMERON2,3,4, HG HEALY2,3,4, R FASSETT2,5,6, WE HOY2,3
1Darling Downs Hospital And Health Service, Toowoomba, Australia, 2NHMRC CKD.CRE and CKD.QLD, The University of Queensland, Brisbane, Australia, 3School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia, 4Kidney Health Service (RBWH), Metro North Hospital and Health Service, Brisbane, Australia, 5School of Human Movement Studies, The University of Queensland, Brisbane, Australia, 6Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
Aim: To explore the association between monoclonal gammopathies and chronic kidney disease (CKD)
Background: Chronic kidney disease (CKD) is a common complication of monoclonal gammopathies with multiple myeloma being the most widely recognized. In 2012, the International Kidney and Monoclonal Gammopathy (MG) Research Group introduced a new term, monoclonal gammopathy of renal significance (MGRS), which describes a group of renal disorders caused by a monoclonal immunoglobulin, or its components.
Methods: Records of CKD registry of patients attending renal clinics from the Darling Downs with documented monoclonal gammopathies were reviewed for demographic profile, renal biopsy rates, diagnostic ascertainment of CKD.
Results: A total of 27 (1.9%) cases were identified from 1400 recruited to the CKD Registry, with a median age of 68.9 years with male preponderance (59.2%). A quarter of them (7/27) had confirmed multiple myeloma. Of the remaining 20 cases MGRS was diagnosed by renal histology in four (20%) with one each of AL amyloidosis, fibrillary nephropathy, monoclonal immune deposition disease (MIDD) and monoclonal related membranoproliferative glomerulonephritis (MPGN). Low-grade B-cell lymphoma was associated with two cases. The remaining 16 (59.2%) were documented as monoclonal gammopathy of undetermined significance (MGUS) with two had unrelated histology on renal biopsy (FSGS and membranous nephropathy). Kidney biopsy was performed in 7 (25%) cases only. Remaining 14 cases were listed other aetiologias for renal disease without kidney biopsy.
Conclusion: Kidney biopsy was not done in half of CKD patients with paraproteinemia (MGUS) to ascertain the association of MG with kidney disease. Kidney biopsy may be considered in cases that would be otherwise labelled as MGUS, as potentially disease altering treatments for MGRS are being withheld.
Sally Wilkinson is a basic physician trainee at Toowoomba Hospital. She is passionate about research involving chronic kidney disease especially the relation between cancer and CKD. She propose to pursue her advance traineeship in both Nephrology and Onchology