title: Renal outcome and monoclonal immunoglobulin deposition disease in 289 old patients with blood cell dyscrasias: a single center experience.
abstract: Monoclonal components (MC) formed by chains/fragments of intact/truncated globulin components produced in different lymphoproliferative diseases are responsible for monoclonal immunoglobulin deposition disease (MIDD) and consequent tissue damage by organized (amyloid fibrils) or non-organized (amorphous) deposits. The kidneys are the most commonly affected organs in MIDD, and renal failure represents an important adverse factor for prognosis. The renal outcome and the role of renal pathology in diagnosing MIDD was evaluated in 289 elderly patients with multiple myeloma (MM, n=115) and monoclonal gammopathy (MGUS, n=174). Renal impairment was the only significant risk factor for patient death, while significant risk factors for renal impairment were diabetes (HR 3.65, 95% CI: 2.08-6.41), light chain (LC) proteinuria (HR 2.18; 95% CI: 1.10-4.32) and type of MC (p=0.0019). Renal pathology documented MIDD in 12/30 cases (40%): six cases of AL-amyloidosis, two of LC disease, one of heavy chain disease and three of cast nephropathy, as well as four cases of glomerulonephritis, eight of arteriolosclerosis and six of normal picture. Main conclusions are that diabetes, sharing common glomerular damage with LC disease, is the strongest risk factor for progression of renal disease, and glomerular proteinuria or heavy LC proteinuria should raise a strong suspicion index of MIDD and prompt pathology assessment to reach the correct diagnosis.
authors.affiliation: Department of Clinical and Experimental Medicine, Units Nephrology and Transplantation, Department of Nephro-Urology, & Interdisciplinary Research Center Autoimmune Disease (IRCAD), Amedeo Avogadro University, Novara, Italy. strattanefro@hotmail.com
authors.forename: Piero
authors.initials: P
authors.lastname: Stratta
authors.forename: Luciana
authors.initials: L
authors.lastname: Gravellone
authors.forename: Tiziana
authors.initials: T
authors.lastname: Cena
authors.forename: Davide
authors.initials: D
authors.lastname: Rossi
authors.forename: Gianluca
authors.initials: G
authors.lastname: Gaidano
authors.forename: Roberta
authors.initials: R
authors.lastname: Fenoglio
authors.forename: Elisa
authors.initials: E
authors.lastname: Lazzarich
authors.forename: Marco
authors.initials: M
authors.lastname: Quaglia
authors.forename: Andrea
authors.initials: A
authors.lastname: Airoldi
authors.forename: Cristina
authors.initials: C
authors.lastname: Bozzola
authors.forename: Guido
authors.initials: G
authors.lastname: Monga
authors.forename: Guido
authors.initials: G
authors.lastname: Valente
authors.forename: Caterina
authors.initials: C
authors.lastname: Canavese
authors.forename: Corrado
authors.initials: C
authors.lastname: Magnani
mesh_terms: D000368:Aged; D001773:Blood Cells / Q000473:pathology*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000175:diagnosis; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis; D010265:Paraproteinemias / Q000150:complications* / Q000175:diagnosis; D012307:Risk Factors; D016896:Treatment Outcome