MGRS: One of the nephrological challenges of the 21st century

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Mariana Ciocchini

University of Buenos Aires, Argentina

: J Nephrol Ren Dis

Abstract

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Monoclonal gammopathy of renal significance (MGRS) is a recently described hemato-nephrological metaentity whose pathogenesis depends on monoclonal immunoglobulins (Ig) or humoral factors secreted by small B-cell clones affecting any nephronal area with a broad spectrum of histopathological patterns and even the presence of, at least, two different kinds of MGRS in the same patient. The importance of MGRS is based on its association with an increased morbidity and mortality, included its recurrence in post-renal transplant period and even as “de novo” presentation; and its improvement after performing the cell-B clone treatment. The relevance of renal biopsy in nephrological practice depends on its reliability to achieve a precise MGRS diagnosis which may be the only indication for hematological treatment. Kidney injury mediated by monoclonal Ig is mainly the result of its deposit in renal tissue, as is the case of light chain deposition disease. Monoclonal Ig can also have auto-antibody activity which is responsible for a cluster of disorders related to the dysregulation of the alternative pathway of complement, for example, C3 glomerulopathy with a big impact in the difficult treatment of its. The third pathophysiological mechanism depends on humoral factors like in POEMS syndrome’s nephropathy. Taking into account only one type of paraproteinemia, the monoclonal gammopathy of undetermined significance, MGRS’s prevalence is being estimated around 0.32 and 0.57 % depending on the population age. MGRS as a meta-entity is changing nephrological paradigms related to diagnosis, treatment and prognosis, and this is a fascinating challenge which a multidisciplinary approach.

Biography

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Mariana Ciocchini is MD by the National University of La Plata and Nephrologist by the University of Buenos Aires. Her research is focused on monoclonal gammopathy of renal significance and she has published papers about this subject in a reputed journal. She is a member of the Glomerulopathy Council, ANBA, Argentinian Society of Nephrology being one of the co-authors of the book “Glomerular diseases” recently published by this group.