Monoclonal gammopathy of renal significance: when MGUS is no longer undetermined or insignificant
Monoclonal gammopathy of renal significance: when MGUS is no longer undetermined or insignificant
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DOI：
10.1182/blood-2012-07-445304
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发表时间：
2012-11-22
期刊：
影响因子：
20.3
通讯作者：
Kyle, Robert A.
中科院分区：
文献类型：
--
作者：
Leung, Nelson;Bridoux, Frank;Kyle, Robert A.
多发性骨髓瘤是最常见的单克隆丙种球蛋白病，涉及肾脏;然而，越来越多的肾脏疾病与其他单克隆丙种球蛋白病正在被确认。虽然存在许多组织病理学模式，但它们都通过单克隆免疫球蛋白（或组分）沉积来区分。与多发性骨髓瘤相比，这些患者的血液系统疾病更符合意义不明的单克隆丙种球蛋白病（MGUS）。不幸的是，由于目前诊断模式的局限性，他们经常被诊断为MGUS。由于不建议对MGUS进行治疗，因此通常不进行适当的治疗。除了终末期肾病，单克隆丙种球蛋白病的持续存在与肾移植后高复发率有关。成功的针对负责任克隆的治疗可以保护和恢复肾功能。血液学完全缓解的实现已被证明可以预防肾移植后的复发。需要一个术语来恰当地表达这些疾病的病理性质。我们认为术语“肾脏意义的单克隆丙种球蛋白病”最有助于表明单克隆丙种球蛋白病与肾脏损害之间的因果关系，并且因为单克隆丙种球蛋白病的意义不再不确定。（血。2012;120（22）：4292-4295）
Multiple myeloma is the most frequent monoclonal gammopathy to involve the kidney; however, a growing number of kidney diseases associated with other monoclonal gammopathies are being recognized. Although many histopathologic patterns exist, they are all distinguished by the monoclonal immunoglobulin (or component) deposits. The hematologic disorder in these patients is more consistent with monoclonal gammopathy of undetermined significance (MGUS) than with multiple myeloma. Unfortunately, due to the limitations of the current diagnostic schema, they are frequently diagnosed as MGUS. Because treatment is not recommended for MGUS, appropriate therapy is commonly withheld. In addition to end-stage renal disease, the persistence of the monoclonal gammopathy is associated with high rates of recurrence after kidney transplantation. Preservation and restoration of kidney function are possible with successful treatment targeting the responsible clone. Achievement of hematologic complete response has been shown to prevent recurrence after kidney transplantation. There is a need for a term that properly conveys the pathologic nature of these diseases. We think the term monoclonal gammopathy of renal significance is most helpful to indicate a causal relationship between the monoclonal gammopathy and the renal damage and because the significance of the monoclonal gammopathy is no longer undetermined. (Blood. 2012;120(22):4292-4295)