Renal damage by monoclonal immunoglobulin and/ or free light chains Classification according to the „International Kidney and Monoclonal Gammopathy Research Group“

Czech version

Authors: Z. Adam ¹; M. Kment ²; T. Roháľ ³; J. Řehořová ⁴; M. Krejčí ¹; Z. Král ¹; L. Pour ¹
Authors‘ workplace: Interní hematologická a onkologická klinika LF MU a FN Brno ¹; Institut klinické a experimentální medicíny, Pracoviště klinické a transplantační patologie, Praha ²; Institut klinické a experimentální medicíny (IKEM), Klinika nefrologie, Praha ³; Interní gastroenterologická klinika LF MU a FN Brno ⁴
Published in: Transfuze Hematol. dnes,31, 2025, No. 3, p. 158-167.
Category: Review/Educational Papers
doi: https://doi.org/10.48095/cctahd2025prolekare.cz7

Overview

Monoclonal gammopathy of renal significance (MGRS) was defined in 2012 as etiopathogenetically related kidney damage associated with free light chain (FLC) or monoclonal immunoglobulin (M-Ig). The prevalence of MGRS is described in only two studies. An analysis from the Mayo Clinic found that in a population over the age of 50, light chain monoclonal gammopathy of undetermined significance (MGUS) was present in 0.8% of individuals, and among them, 23% had kidney damage. Another analysis reported that 10% of individuals with monoclonal gammopathy who seemingly meet the criteria for MGUS suffer from some form of organ damage, which corresponds to 0.32% of individuals over 50 years old and 0.53% of those over 70. Kidney damage from free light chains and/or monoclonal immunoglobulin is therefore more common than diagnosed. The nomenclature and definition of individual forms of kidney injury within MGRS was developed by the International Kidney and Monoclonal Gammopathy Research Group. The classification, published in 2019, consists of two main categories. The first category includes kidney damage caused by M-Ig with deposits of M-Ig, or its components, in the kidneys. This category is further divided into two basic subcategories, organized and unorganized (amorphous) M-Ig deposits. The second category includes kidney damage caused by M-Ig without M-Ig deposits, or parts of it, in the kidneys. The goal of treatment for all forms of MGRS is the eradication of the cellular clone producing nephrotoxic FLC or nephrotoxic M-Ig. To achieve this goal, it is necessary to use the most effective drugs including anti-CD38 monoclonal antibodies. The aim of this text is to provide a brief overview of the morphological classification of MGRS and current treatment approaches.

Keywords:

monoclonal gammopathy of renal significance

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PODÍL AUTORŮ NA PŘÍPRAVĚ RUKOPISU

Výsledná podoba textu je syntézou morfologického a klinického pohledu na problematiku.

Martin Kment je autorem morfologických částí textu.

Tomáš Roháľ a Jitka Řehořová jsou autory nefrologického pohledu.

Zdeněk Adam, Luděk Pour, Marta Krejčí a Zdeněk Král jsou autoři hematologického pohledu.

ČESTNÉ PROHLÁŠENÍ

Autoři práce prohlašují, že v souvislosti s tématem, vznikem a publikací tohoto článku nejsou ve střetu zájmů a vznik ani publikace článku nebyly podpořeny žádnou farmaceutickou firmou.

Doručeno do redakce dne: 17. 12. 2024.

Přijato po recenzi dne: 20. 1. 2025.

prof. MUDr. Zdeněk Adam, CSc.

Interní hematologická a onkologická klinika

LF MU a FN Brno

Jihlavská 20

625 00 Brno Bohunice

e-mail: adam.zdenek@fnbrno.cz

MUDr. Tomáš Roháľ

Institut klinické a experimentální medicíny (IKEM)

Klinika nefrologie

Vídeňská 1958