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Gutiérrez-Peredo GB, Filho JCBO, Montaño-Castellón I, Gutiérrez-Peredo AJ, Crusoé EDQ, Gusmao-Flores D. Lambda light chain-induced monoclonal gammopathy of renal significance, manifesting with Fanconi Syndrome and osteomalacia. BMC Nephrol 2022; 23:278. [PMID: 35945525 PMCID: PMC9364558 DOI: 10.1186/s12882-022-02901-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monoclonal gammopathy of renal significance (MGRS) encompasses a heterogeneous group of kidney diseases in which a monoclonal immunoglobulin secreted by a clone of B cells or plasma cells causes kidney damage without meeting the hematological criteria for malignancy. Among the various forms of involvement, MGRS can manifest as a proximal tubule disorder, such as Fanconi syndrome (FS), characterized by urinary loss of phosphate, glucose, amino acids, uric acid and bicarbonate. Few cases of MGRS have been described in the literature, manifesting as FS and monoclonal production of lambda light chains, almost all of which are secondary to the production of kappa light chains. CASE PRESENTATION Here we report a clinical case of a 45-year-old Brazilian male, African descent, with proximal weakness of the lower limbs, whose initial assessment showed a urine summary with the presence of proteinuria and glycosuria without hyperglycemia, associated with mild worsening of renal function, hypouricemia, hypocalcemia and phosphaturia. Evolution was characterized by a MGRS manifesting as FS and osteomalacia. CONCLUSION The diagnosis of MGRS is not always easy, it requires knowledge of the clinical characteristics, diagnostic criteria and prognosis of each case. Therefore, all possible efforts should be made for multidisciplinary diagnosis.
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Affiliation(s)
- Gabriel Brayan Gutiérrez-Peredo
- University Hospital Professor Edgard Santos, Salvador, Bahia, CEP: 40110-060, Brazil. .,Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil. .,Gerência de Ensino, Pesquisa e Extensão - GEPE, University Hospital Professor Edgard Santos, Salvador, Brazil. .,Nephrology Service, University Hospital Professor Edgard Santos, Salvador, Brazil.
| | - José César Batista Oliveira Filho
- University Hospital Professor Edgard Santos, Salvador, Bahia, CEP: 40110-060, Brazil.,Nephrology Service, University Hospital Professor Edgard Santos, Salvador, Brazil
| | - Iris Montaño-Castellón
- University Hospital Professor Edgard Santos, Salvador, Bahia, CEP: 40110-060, Brazil.,Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil.,Gerência de Ensino, Pesquisa e Extensão - GEPE, University Hospital Professor Edgard Santos, Salvador, Brazil.,Neurology Service, University Hospital Professor Edgard Santos, Salvador, Brazil
| | - Andrea Jimena Gutiérrez-Peredo
- University Hospital Professor Edgard Santos, Salvador, Bahia, CEP: 40110-060, Brazil.,Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil.,Gerência de Ensino, Pesquisa e Extensão - GEPE, University Hospital Professor Edgard Santos, Salvador, Brazil
| | - Edvan de Queiroz Crusoé
- University Hospital Professor Edgard Santos, Salvador, Bahia, CEP: 40110-060, Brazil.,Onco-Hematology Service, University Hospital Professor Edgard Santos, Salvador, Brazil
| | - Dimitri Gusmao-Flores
- University Hospital Professor Edgard Santos, Salvador, Bahia, CEP: 40110-060, Brazil.,Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil
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Li M, Xu G. An update of proliferative glomerulonephritis with monoclonal immunoglobulin deposits. Clin Kidney J 2021; 15:1041-1048. [PMID: 35664272 PMCID: PMC9155251 DOI: 10.1093/ckj/sfab269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
As aging increases, monoclonal gammopathy is becoming more common, and monoclonal gammopathy of renal significance (MGRS) is gaining attention due to frequent renal involvement. Among MGRS, proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is a special category. The disease was first described in 2004, and the research history on it is relatively short. Compared with other MGRS, the detection rate of circulating clones is lower in patients with PGNMID, which is easy to be missed and misdiagnosed in clinical work. In this review, the etiology and clinical features of PGNMID are discussed. It is noted that PGNMID is not only associated with MGRS, but also with malignancy, infection, and other factors. PGNMID is not a disease exclusive to the elderly, young people can also develop this disease. Due to the low detection rate of circulating clones in most patients, confirmation of the disease needs to be combined with renal pathology, which emphasizes the importance of completing light and heavy chain subtype staining. Treatment options for patients with PGNMID differ by etiology. For MGRS-associated PGNMID, the current treatment is primarily empirical and more research evidence is needed to fill the treatment gap.
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Affiliation(s)
- Manna Li
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, China
| | - Gaosi Xu
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, China
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Jerbi M, El Fatmi R, Gaied H, Belloumi D, Torjemane L, Aoudia R, Goucha R, Abdallah TB, Othman TB. Proliferative glomerulonephritis with monoclonal immunoglobulin deposits: Successful treatment for new and rare entity. Clin Case Rep 2021; 9:80-85. [PMID: 33489136 PMCID: PMC7813026 DOI: 10.1002/ccr3.3439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/12/2020] [Accepted: 10/03/2020] [Indexed: 12/04/2022] Open
Abstract
Proliferative glomerulonephritis with monoclonal immunoglobulin deposits is a new disorder with undefined treatment modalities. We propose cyclophosphamide-bortezomib-dexamethasone and autologous stem cell transplantation as a therapeutic protocol.
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Affiliation(s)
- Mouna Jerbi
- Department of NephrologyMongi Slim HospitalLa MarsaTunisia
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
| | - Rym El Fatmi
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
- Department of HematologyCentre National de Greffe de Moelle OsseuseTunisTunisia
| | - Hanene Gaied
- Department of NephrologyMongi Slim HospitalLa MarsaTunisia
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
| | - Dorra Belloumi
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
- Department of HematologyCentre National de Greffe de Moelle OsseuseTunisTunisia
| | - Lamia Torjemane
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
- Department of HematologyCentre National de Greffe de Moelle OsseuseTunisTunisia
| | - Raja Aoudia
- Department of NephrologyCharles Nicolle HospitalTunisTunisia
| | - Rim Goucha
- Department of NephrologyMongi Slim HospitalLa MarsaTunisia
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
| | - Taieb Ben Abdallah
- Faculty of Medicine TunisUniversity of Tunis El ManarTunisTunisia
- Department of NephrologyCharles Nicolle HospitalTunisTunisia
| | - Tarek Ben Othman
- Department of HematologyCentre National de Greffe de Moelle OsseuseTunisTunisia
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