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Poster Presentation

Clinical and pathological analysis of patient presenting renal lesion and monoclonal gammopathy: a retrospective study of 64 patients with biopsy-proven renal diseases

Dr Li Chao
Chinese Academy of Medicine Sciences & Peking Union Medical College

Abstract

Background

We characterized the spectrum of renal diseases associated with monoclonal gammopathy and unrelated renal diseases.

Methods

Hospitalized patients in PUMCH who underwent renal biopsy between January, 2013 and December, 2015. They had monoclonal gammopathy on serum protein electrophoresis (SPE), serum immunofixation electrophoresis (IFE), urine IFE and/or serum free light chain (FLC). 64 patients met the inclusion criteria and were classified into MGRS (n=36), MGUS (n=17) and hematologic malignancy (n=11).

Results

  1. Renal lesions in MGRS subgroup included light chain amyloidosis (AL) (n=28, 77.8%), light chain deposition disease (LCDD) (n=7,19.4%), and fibrillary glomerulopathy (n=1, 2.8%).
  2. Renal diseases in MGUS subgroup included membranous nephropathy (n=10), FSGS (n=3), diabetic glomerulopathy (n=1), Henoch-Schonlein purpura nephritis (n=1), anti-GBM disease concurrent with MN(n=1) and glomerulomegaly (n=1).
  3. Various renal lesions related/unrelated to hematologic malignancy were seen in third subgroup, including light chain cast nephropathy (n=3), tubulointerstitial lesions (n=2), LCDD (n=1), IgAN (n=1), MesPGN (n=1), Endocapillary proliferative glomerulonephritis (n=1) and acute tubular necrosis (n=1).
  4. Positive rate of SPE, SIFE and UIFE in MGRS subgroup were 40.6%, 52.8% and 69.4%, respectively. Positive rate of SPE, SIFE and UIFE in MGUS subgroup were 68.8%, 100% and 37.5%, respectively. Positive rate of SPE, SIFE and UIFE in hematologic malignancy subgroup were 54.5%, 72.7% and 81.8%. MGRS and MGUS subgroups differed significantly in positive rate of SIFE (P<0.001). Abnormal rates of serum FLC ratio in above three subgroups were 83.3%, 17.6% and 90.9%, respectively, in which MGUS group was significantly lower than other two groups (P<0.001, P<0.001).

Conclusions

The significance of monoclonal gammopathy in patients with renal disease should be evaluated by other clinical data, as well as renal pathology.