Clin Nephrol. 2023 Dec;100(6):269-274. doi: 10.5414/CN111123.
Monoclonal gammopathy is a heterogeneous group of disorders due to the clonal proliferation of immunoglobulin-producing plasma cells or B lymphocytes. Patients develop kidney disease not only due to malignant transformation but also due to the idiosyncratic properties of the M protein and the host factors. We aim to study the spectrum of kidney diseases in patients with paraproteinemia.
A retrospective observational study was performed at three tertiary care centers in Southern India. Kidney biopsies conducted in these three centers were reviewed from June 1, 2020 to November 30, 2022. All biopsies suggestive of monotypic immunoglobulin or light chain restriction were included in the study.
A total of 122 patients were included in the study with an incidence of 2.4%. The mean age was 52.27 ± 13.27 years, and majority (63.1%) were males. AL amyloidosis was most common in the monoclonal gammopathy of renal significance (MGRS) group, and cast nephropathy was most common in the multiple myeloma (MM) group. On histopathology, 83.6% had a single lesion, followed by 14.8% with double lesion, and 1.6% with triple lesion.
Paraproteinemia is associated with a myriad of kidney lesions. MGRS and MM are usually present in the 6 decade of life and beyond, while proliferative glomerulonephritis with monoclonal immunoglobulin deposits is more common in the younger age group. Older age group, high creatinine, hyperuricemia, hyperphosphatemia, presence of more than one lesion on kidney biopsy, and presence of cast nephropathy was significantly associated with the requirement of kidney replacement therapy.
单克隆丙种球蛋白病是一组由于免疫球蛋白产生的浆细胞或 B 淋巴细胞克隆性增殖引起的异质性疾病。患者发生肾脏疾病不仅是由于恶性转化，还由于 M 蛋白的固有特性和宿主因素。我们旨在研究伴有副蛋白血症的患者的肾脏疾病谱。
在印度南部的三个三级护理中心进行了一项回顾性观察性研究。对这三个中心进行的肾脏活检进行了回顾性研究，研究时间为 2020 年 6 月 1 日至 2022 年 11 月 30 日。所有提示单克隆免疫球蛋白或轻链受限的活检均纳入研究。
本研究共纳入 122 例患者，发病率为 2.4%。平均年龄为 52.27 ± 13.27 岁，大多数（63.1%）为男性。在单克隆丙种球蛋白与肾意义相关的肾疾病（MGRS）组中，AL 淀粉样变性最常见，而在多发性骨髓瘤（MM）组中，铸型肾病最常见。组织病理学上，83.6%的患者有单个病变，其次是 14.8%的患者有双病变，1.6%的患者有三病变。
副蛋白血症与多种肾脏病变有关。MGRS 和 MM 通常发生在 60 岁以上，而伴有单克隆免疫球蛋白沉积物的增生性肾小球肾炎更常见于年轻患者。年龄较大、肌酐升高、高尿酸血症、高磷血症、肾脏活检有多个病变和铸型肾病与需要肾脏替代治疗显著相关。
