Menè Paolo, Moioli Alessandra, Stoppacciaro Antonella, Lai Silvia, Festuccia Francescaromana
Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, 00189 Rome, Italy.
Division of Nephrology, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
J Clin Med. 2021 Aug 28;10(17):3871. doi: 10.3390/jcm10173871.
Monoclonal gammopathies (MG) encompass a variety of disorders related to clonal expansion and/or malignant transformation of B lymphocytes. Deposition of free immunoglobulin (Ig) components (light or heavy chains, LC/HC) within the kidney during MG may result over time in multiple types and degrees of injury, including acute kidney injury (AKI). AKI is generally a consequence of tubular obstruction by luminal aggregates of LC, a pattern known as "cast nephropathy". Monoclonal Ig LC can also be found as intracellular crystals in glomerular podocytes or proximal tubular cells. Proliferative glomerulonephritis with monoclonal Ig deposits is another, less frequent form of kidney injury with a sizable impact on renal function. Hypercalcemia (in turn related to bone reabsorption triggered by proliferating plasmacytoid B cells) may lead to AKI via functional mechanisms. Pharmacologic treatment of MG may also result in additional renal injury due to local toxicity or the tumor lysis syndrome. The present review focuses on AKI complicating MG, evaluating predictors, risk factors, mechanisms of damage, prognosis, and options for treatment.
单克隆丙种球蛋白病（MG）包括多种与B淋巴细胞克隆性扩增和/或恶性转化相关的疾病。MG病程中，游离免疫球蛋白（Ig）成分（轻链或重链，LC/HC）在肾脏内沉积，随着时间的推移可能导致多种类型和程度的损伤，包括急性肾损伤（AKI）。AKI通常是由管腔内LC聚集体导致肾小管梗阻的结果，这种模式称为“管型肾病”。单克隆Ig轻链也可见于肾小球足细胞或近端肾小管细胞内的晶体。伴有单克隆Ig沉积的增生性肾小球肾炎是另一种较少见的肾损伤形式，对肾功能有相当大的影响。高钙血症（继而与增殖的浆细胞样B细胞引发的骨吸收有关）可通过功能机制导致AKI。MG的药物治疗也可能因局部毒性或肿瘤溶解综合征导致额外的肾损伤。本综述重点关注并发MG的AKI，评估预测因素、危险因素、损伤机制、预后及治疗选择。
