Poškození ledvin monoklonálním imunoglobulinem a / nebo volnými lehkými řetězci. Klasifikace dle „International Kidney and Monoclonal Gammopathy Research Group“.

Abstract

Summary

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 showed that 0.8% of people over 50 years of age had light chain MGUS, and 23% of them had kidney damage. Another analysis reported that 10% of people with monoclonal gammopathy who seemed to meet the MGUS criteria suffered some form of damage, corresponding to 0.32% of the population over 50 years of age and 0.53% of those over 70 years of age. Thus, kidney damage from free light chains and/or monoclonal immunoglobulin will be 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 has two main categories. The first category includes kidney damage caused by M-Ig with M-Ig deposits, or parts of it, 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 of all forms of MGRS is to eradicate the cell clone that produces nephrotoxic FLC or nephrotoxic M-Ig. To achieve this goal, it is necessary to use the most effective drugs, which include anti-CD38 monoclonal antibodies.

The aim of this article is to briefly inform about the morphological classification of MGRS and current treatments.

Keywords: monoclonal gammopathy of renal significance