title: New aspects on the pathogenesis of renal disorders related to monoclonal gammopathies.
abstract: BACKGROUND
  Multiple myeloma and other related monoclonal gammopathies are frequently encountered conditions associated with renal damage, especially in elderly population. They are arising from clonal proliferation of plasma cells in bone marrow producing various quantities of abnormal monoclonal immunoglobulins, or their components/fragments.
  
  
  CONCLUSIONS
  These abnormal proteins differ from normal immunoglobulins in the amino acid sequence and in the three-dimensional structure of the molecule, which may determine their toxicity. Kidney seems to be a target organ as a major catabolic site. The pathology of renal disease is highly heterogeneous involving a variety of different mechanisms, which are divided into immunoglobulin dependent and immunoglobulin independent mechanisms. The Ig-dependent mechanisms may involve the four components of the kidney parenchyma, and the primary structure of these proteins determine the pattern of renal disease.
  
  
  CONCLUSIONS
  This review summarizes the existing literature in the pathobiology of multiple myeloma, and the pathological properties of the M-proteins, focusing on the mechanisms of the renal manifestations related to these abnormal proteins, especially glomerular injury. Also it supports the opinion that monoclonal gammopathy of undetermined significance (MGUS) should not be used in cases where there is proven renal impairment due to these proteins, even if it is mild and does not meet the current criteria.
authors: Section of nephrology and hypertension, 1st department of internal medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece.
authors: Stergios
authors: S
authors: Kapoulas
authors: Section of nephrology and hypertension, 1st department of internal medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece. Electronic address: vasraptis@gmail.com.
authors: Vasileios
authors: V
authors: Raptis
authors: Section of hematology, 1st department of internal medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece.
authors: Maria
authors: M
authors: Papaioannou
mesh_terms: D006801:Humans; D007136:Immunoglobulins / Q000737:chemistry* / Q000378:metabolism; D007668:Kidney / Q000378:metabolism; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D009101:Multiple Myeloma / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D009194:Myeloma Proteins / Q000737:chemistry / Q000378:metabolism; D010265:Paraproteinemias / Q000150:complications / Q000175:diagnosis / Q000378:metabolism
chemical_list: D007136:Immunoglobulins; C009823:M-proteins (Myeloma); D009194:Myeloma Proteins
keywords: Amyloidosis; Cast nephropathy; Monoclonal gammopathy of renal significance; Monoclonal gammopathy of undetermined significance; Monoclonal immunoglobulin; Monoclonal immunoglobulin deposition disease; Multiple myeloma