Renal monoclonal immunoglobulin deposition disease: the disease spectrum.
This study reports the clinicopathologic findings and outcome in 34 patients with renal monoclonal immunoglobulin deposition disease (MIDD), which included 23 light-chain DD (LCDD), 5 light- and heavy-chain DD (LHCDD), and 6 heavy-chain DD (HCDD). A total of 23 patients had pure MIDD, whereas 11 patients had LCDD with coexistent myeloma cast nephropathy (LCDD & MCN). Renal biopsy diagnosis preceded clinical evidence of dysproteinemia in 68% of all cases. By immunofluorescence, the composition of deposits included 11kappa/1lambda (LCDD), 3IgGkappa/2IgGlambda (LHCDD), 5gamma/1alpha (HCDD), and 10kappa/1lambda (LCDD & MCN). Patients with pure MIDD presented with mean serum creatinine of 4.2 mg/dl, nephrotic proteinuria, and hypertension. Cases of HCDD were associated with a CH1 deletion and frequently had hypocomplementemia and a positive hepatitis C virus antibody but negative hepatitis C virus PCR. LCDD & MCN is a morphologically and clinically distinct entity from pure MIDD, presenting with higher creatinine (mean, 7.8 mg/dl; P = 0.01), greater dialysis dependence (64 versus 26%; P = 0.053), subnephrotic proteinuria, and less nodular glomerulopathy (18 versus 100%; P < 0.0001). Multiple myeloma was more frequently diagnosed in LCDD & MCN than in pure MIDD (91 versus 31%; P = 0.025). Renal and patient survivals were significantly worse in patients with LCDD & MCN (mean, 4 and 22 mo, respectively), compared with patients with pure MIDD (mean, 22 and 54 mo). Chemotherapy stabilized or improved renal function in 10 of 15 patients (67%) with pure MIDD who presented with creatinine of <5.0 mg/dl, emphasizing the importance of early detection. On multivariate analysis, initial creatinine was the only predictor of renal and patient survival in pure MIDD, underscoring the prognostic significance of the renal involvement.
Lin
Julie
J
Division of Nephrology, Department of Medicine, Columbia University, New York-Presbyterian Hospital, New York, New York.
Markowitz
Glen S
GS
Department of Pathology, Columbia University, New York-Presbyterian Hospital, New York, New York.
Valeri
Anthony M
AM
Division of Nephrology, Department of Medicine, Columbia University, New York-Presbyterian Hospital, New York, New York.
Kambham
Neeraja
N
Department of Pathology, Columbia University, New York-Presbyterian Hospital, New York, New York.
Sherman
William H
WH
Division of Oncology, Department of Medicine, Columbia University, New York-Presbyterian Hospital, New York, New York.
Appel
Gerald B
GB
Division of Nephrology, Department of Medicine, Columbia University, New York-Presbyterian Hospital, New York, New York.
D'Agati
Vivette D
VD
Department of Pathology, Columbia University, New York-Presbyterian Hospital, New York, New York.
D000368:Aged; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000378:metabolism*; D007147:Immunoglobulin Light Chains / Q000378:metabolism*; D007668:Kidney / Q000378:metabolism / Q000473:pathology; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis
D007143:Immunoglobulin Heavy Chains; D007147:Immunoglobulin Light Chains