title: Renal lesions associated with plasma cell dyscrasias: practical approach to diagnosis, new concepts, and challenges.
abstract: BACKGROUND
  Patients with plasma cell dyscrasias (myeloma) may exhibit a variety of renal manifestations as a result of damage from circulating light- and heavy-chain immunoglobulin components produced by the neoplastic plasma cells. The renal alterations can occur in any of the renal compartments, and in a significant number of the cases more than one compartment is affected. Research in the laboratory has helped considerably in providing a solid conceptual understanding of how renal damage occurs.
  
  
  OBJECTIVE
  To detail advances that have been made in the diagnosis of these conditions and to provide an account of research accomplishments that have solidified diagnostic criteria. The new knowledge that has been acquired serves to provide a solid platform for the future design of new therapeutic interventions aimed at ameliorating or abolishing the progressive renal damage that typically takes place.
  
  
  METHODS
  Translational efforts have substantially contributed to elucidate mechanistically the molecular events responsible for the renal damage. The spectrum of renal manifestations associated with plasma cell dyscrasias has expanded significantly in the last 10 years. Diagnostic criteria have also been refined. This information has been summarized from work done at several institutions.
  
  
  CONCLUSIONS
  A number of significant challenges remain in the diagnosis of these conditions, some of which will be discussed in this article. Dealing with these challenges will require additional translational efforts and close cooperation between basic researchers, clinicians, and pathologists in order to improve the diagnostic tools available to renal pathologists and to acquire a more complete understanding of clinical and pathologic manifestations associated with these conditions.
authors.affiliation: Pathology Department, Nephrocor Laboratory, 1700 N Desert Drive, Tempe, AZ 85281, USA. gherrera@bostwicklaboratories.com
authors.forename: Guillermo A
authors.initials: GA
authors.lastname: Herrera
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D001706:Biopsy; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000378:metabolism; D007147:Immunoglobulin Light Chains / Q000378:metabolism; D007674:Kidney Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D007687:Kidney Tubules, Proximal / Q000378:metabolism / Q000473:pathology* / Q000648:ultrastructure; D009101:Multiple Myeloma / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D009395:Nephritis, Interstitial / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D010265:Paraproteinemias / Q000150:complications* / Q000378:metabolism
chemical_list: D007143:Immunoglobulin Heavy Chains; D007147:Immunoglobulin Light Chains