Abstract: FR-PO742

Clinical and Pathological Analysis of Patient Presenting Renal Lesion and Monoclonal Gammopathy: A Retrospective Study of 64 Patients with Biopsy-Proven Renal Diseases

Session Information

Category: Glomerular

  • 1004 Clinical/Diagnostic Renal Pathology and Lab Medicine

Authors

  • Li, Chao, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences & Peking Union Medical College, Beijing, China
  • Wen, Yubing, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences & Peking Union Medical College, Beijing, China
  • Li, Hang, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences & Peking Union Medical College, Beijing, China
  • Cai, Jianfang, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences & Peking Union Medical College, Beijing, China
  • Li, Xuemei, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences & Peking Union Medical College, Beijing, China
  • Li, Xuewang, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences & Peking Union Medical College, Beijing, China
Background

Patients with monoclonal gammopathy can develop a variety of related renal lesions or possibly have kidney disease unrelated to their monoclonal gammopathy. We characterized the spectrum of renal diseases associated with monoclonal gammopathy and unrelated renal diseases.

Methods

Hospitalized patients in Peking Union Medical College Hospital 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 as MGRS (n=36), MGUS (n=17) and hematologic malignancy (n=11).

Results

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%). Renal diseases in MGUS subgroup included membranous nephropathy (n=10, 58.8%), FSGS (n=3, 17.6%), diabetic glomerulopathy (n=1, 5.9%), Henoch-Schonlein purpura nephritis (n=1, 5.9%), anti-GBM disease concurrent with membranous nephropathy (n=1, 5.9%) and glomerulomegaly (n=1, 5.9%). Various renal lesions related/unrelated to hematologic malignancy were seen in third subgroup, including light chain cast nephropathy (n=3, 27.3%), tubulo-interstitial lesions (n=2, 18.2%), LCDD(n=1, 9.1%), IgA nephropathy (n=1, 9.1%), MesPGN (n=1, 9.1%), endocapillary proliferative glomerulonephritis (n=1, 9.1%) and acute tubular necrosis (n=1, 9.1%). 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).

Conclusion

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