TY - JOUR
T1 - Clinical characteristics of monoclonal immunoglobulin-associated renal disease
T2 - a retrospective cohort study
AU - Narimiya, Toshiyuki
AU - Hayashi, Hiroki
AU - Ogata, Soshiro
AU - Hara, Shigeo
AU - Okamoto, Akinao
AU - Takahashi, Kazuo
AU - Koide, Shigehisa
AU - Inaguma, Daijo
AU - Hasegawa, Midori
AU - Tomita, Akihiro
AU - Yuzawa, Yukio
AU - Tsuboi, Naotake
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Japanese Society of Nephrology 2024.
PY - 2024
Y1 - 2024
N2 - Introduction: Clinical epidemiological data on monoclonal gammopathy of renal significance (MGRS) are lacking. In this retrospective observational study, MGRS was compared with B-cell or plasma cell malignancies (BCM/PCM) with renal involvement to clarify differences in their clinical features. Methods: Among the 1408 renal biopsies performed at our hospital, 25 MGRS and 18 BCM/PCM patients were identified. We investigated baseline characteristics and hematologic parameters of MGRS in reference to BCM/PCM using multivariable analysis. Cox proportional hazards analysis was performed for end-stage kidney disease (ESKD) and all-cause mortality. Results: Comparing the MGRS with the BCM/PCM, mean differences in creatinine level, estimated glomerular filtration rate, and clonal bone marrow plasma cell percentage were − 2.76 mg/dL, 27.72 mL/min/1.73 m2, and − 18.86%, respectively (all P < 0.001). MGRS group had a predominance of glomerular lesions such as immunoglobulin-associated amyloidosis, cryoglobulinemic GN, and MIDD, and a lower risk of acute kidney injury/acute renal disease compared to BCM/PCM. During a median observation period of 23.7 months, clone-directed therapy was performed in 32.0% of patients in the MGRS group, compared to 83.3% of patients in the BCM/PCM group. Compared with BCM/PCM, MGRS had a hazard ratio of 0.66 (95% confidence interval (CI) 0.23–1.92, P = 0.45) for ESKD and 0.33 (95% CI 0.11–1.03, P = 0.06) for death in multivariate logistic regression analysis. Conclusions: The clinical characteristics of MGRS and BCM/PCM with monoclonal immunoglobulin-associated renal disease are disparate. Understanding these differences is crucial for developing tailored clinical approaches and therapeutic strategies to improve patient outcome.
AB - Introduction: Clinical epidemiological data on monoclonal gammopathy of renal significance (MGRS) are lacking. In this retrospective observational study, MGRS was compared with B-cell or plasma cell malignancies (BCM/PCM) with renal involvement to clarify differences in their clinical features. Methods: Among the 1408 renal biopsies performed at our hospital, 25 MGRS and 18 BCM/PCM patients were identified. We investigated baseline characteristics and hematologic parameters of MGRS in reference to BCM/PCM using multivariable analysis. Cox proportional hazards analysis was performed for end-stage kidney disease (ESKD) and all-cause mortality. Results: Comparing the MGRS with the BCM/PCM, mean differences in creatinine level, estimated glomerular filtration rate, and clonal bone marrow plasma cell percentage were − 2.76 mg/dL, 27.72 mL/min/1.73 m2, and − 18.86%, respectively (all P < 0.001). MGRS group had a predominance of glomerular lesions such as immunoglobulin-associated amyloidosis, cryoglobulinemic GN, and MIDD, and a lower risk of acute kidney injury/acute renal disease compared to BCM/PCM. During a median observation period of 23.7 months, clone-directed therapy was performed in 32.0% of patients in the MGRS group, compared to 83.3% of patients in the BCM/PCM group. Compared with BCM/PCM, MGRS had a hazard ratio of 0.66 (95% confidence interval (CI) 0.23–1.92, P = 0.45) for ESKD and 0.33 (95% CI 0.11–1.03, P = 0.06) for death in multivariate logistic regression analysis. Conclusions: The clinical characteristics of MGRS and BCM/PCM with monoclonal immunoglobulin-associated renal disease are disparate. Understanding these differences is crucial for developing tailored clinical approaches and therapeutic strategies to improve patient outcome.
KW - Clone-directed therapy
KW - End-stage renal disease
KW - MGRS-associated renal disease
KW - Monoclonal gammopathy of renal significance
UR - http://www.scopus.com/inward/record.url?scp=85208916452&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85208916452&partnerID=8YFLogxK
U2 - 10.1007/s10157-024-02552-0
DO - 10.1007/s10157-024-02552-0
M3 - Article
AN - SCOPUS:85208916452
SN - 1342-1751
JO - Clinical and Experimental Nephrology
JF - Clinical and Experimental Nephrology
ER -