Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise
<i>Background</i>: The simultaneous occurrence of impaired kidney function and paraproteinemia is common in our constantly aging society. Both can be independent entities; however, renal insufficiency can also be caused by the paraprotein. We assessed all kidney biopsies in patients with...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-08-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/12/8/1912 |
| _version_ | 1797432310841212928 |
|---|---|
| author | David Klank Martin Hoffmann Stefan Porubsky Raoul Bergner |
| author_facet | David Klank Martin Hoffmann Stefan Porubsky Raoul Bergner |
| author_sort | David Klank |
| collection | DOAJ |
| description | <i>Background</i>: The simultaneous occurrence of impaired kidney function and paraproteinemia is common in our constantly aging society. Both can be independent entities; however, renal insufficiency can also be caused by the paraprotein. We assessed all kidney biopsies in patients with monoclonal gammopathy in our clinic over the past 20 years and evaluated the histological results. <i>Methods</i>: Biopsies were systematically performed in nearly all patients with paraproteinemia and impaired kidney function (<i>n</i> = 178). The histological findings were systematically evaluated and correlated with the initial clinical diagnosis. <i>Results</i>: We found cast nephropathy (CN) in <i>n</i> = 66 (37.1%) biopsies, AL amyloidosis in <i>n</i> = 31 (17.4%) biopsies, monoclonal immunoglobulin deposition disease (MIDD) in <i>n</i> = 7 (3.9%) biopsies and other renal diseases (ORDs) in <i>n</i> = 74 (41.6%) biopsies. In the latter group, paraprotein-associated changes were found in 37 of 74 (50%) patients, whereas paraprotein-independent changes were found in the other half. Whereas, in the group of patients with MGUS, the findings were heterogenous, most of the patients with known multiple myeloma (MM) or B-NHL showed malignancy-associated changes in the kidney. The biopsy changed the diagnoses in a significant proportion of the patients: The group of patients with MM grew from 71 to 112 patients, whereas, in the MGUS group, only 31 of 44 patients remained. <i>Conclusion</i>: Kidney biopsies in patients with paraproteinemia and renal impairment show a wide range of findings that can lead to a change in diagnosis. |
| first_indexed | 2024-03-09T09:58:33Z |
| format | Article |
| id | doaj.art-9df3d127173349db91a9ac5828381c3e |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T09:58:33Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-9df3d127173349db91a9ac5828381c3e2023-12-01T23:36:22ZengMDPI AGDiagnostics2075-44182022-08-01128191210.3390/diagnostics12081912Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a SurpriseDavid Klank0Martin Hoffmann1Stefan Porubsky2Raoul Bergner3Medizinische Klinik A, Klinikum der Stadt Ludwigshafen gGmbH, Bremserstrasse 79, 67063 Ludwigshafen, GermanyMedizinische Klinik A, Klinikum der Stadt Ludwigshafen gGmbH, Bremserstrasse 79, 67063 Ludwigshafen, GermanyInstitut für Pathologie, Universitätsklinikum Mainz, Langenbeckstrasse 1, 55131 Mainz, GermanyMedizinische Klinik A, Klinikum der Stadt Ludwigshafen gGmbH, Bremserstrasse 79, 67063 Ludwigshafen, Germany<i>Background</i>: The simultaneous occurrence of impaired kidney function and paraproteinemia is common in our constantly aging society. Both can be independent entities; however, renal insufficiency can also be caused by the paraprotein. We assessed all kidney biopsies in patients with monoclonal gammopathy in our clinic over the past 20 years and evaluated the histological results. <i>Methods</i>: Biopsies were systematically performed in nearly all patients with paraproteinemia and impaired kidney function (<i>n</i> = 178). The histological findings were systematically evaluated and correlated with the initial clinical diagnosis. <i>Results</i>: We found cast nephropathy (CN) in <i>n</i> = 66 (37.1%) biopsies, AL amyloidosis in <i>n</i> = 31 (17.4%) biopsies, monoclonal immunoglobulin deposition disease (MIDD) in <i>n</i> = 7 (3.9%) biopsies and other renal diseases (ORDs) in <i>n</i> = 74 (41.6%) biopsies. In the latter group, paraprotein-associated changes were found in 37 of 74 (50%) patients, whereas paraprotein-independent changes were found in the other half. Whereas, in the group of patients with MGUS, the findings were heterogenous, most of the patients with known multiple myeloma (MM) or B-NHL showed malignancy-associated changes in the kidney. The biopsy changed the diagnoses in a significant proportion of the patients: The group of patients with MM grew from 71 to 112 patients, whereas, in the MGUS group, only 31 of 44 patients remained. <i>Conclusion</i>: Kidney biopsies in patients with paraproteinemia and renal impairment show a wide range of findings that can lead to a change in diagnosis.https://www.mdpi.com/2075-4418/12/8/1912paraproteinmultiple myelomakidney biopsyAL amyloidosismonoclonal immunoglobulin deposition disease |
| spellingShingle | David Klank Martin Hoffmann Stefan Porubsky Raoul Bergner Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise Diagnostics paraprotein multiple myeloma kidney biopsy AL amyloidosis monoclonal immunoglobulin deposition disease |
| title | Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise |
| title_full | Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise |
| title_fullStr | Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise |
| title_full_unstemmed | Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise |
| title_short | Histological Findings in Kidney Biopsies of Patients with Monoclonal Gammopathy—Always a Surprise |
| title_sort | histological findings in kidney biopsies of patients with monoclonal gammopathy always a surprise |
| topic | paraprotein multiple myeloma kidney biopsy AL amyloidosis monoclonal immunoglobulin deposition disease |
| url | https://www.mdpi.com/2075-4418/12/8/1912 |
| work_keys_str_mv | AT davidklank histologicalfindingsinkidneybiopsiesofpatientswithmonoclonalgammopathyalwaysasurprise AT martinhoffmann histologicalfindingsinkidneybiopsiesofpatientswithmonoclonalgammopathyalwaysasurprise AT stefanporubsky histologicalfindingsinkidneybiopsiesofpatientswithmonoclonalgammopathyalwaysasurprise AT raoulbergner histologicalfindingsinkidneybiopsiesofpatientswithmonoclonalgammopathyalwaysasurprise |