Paraprotein-Related Kidney Disease: Glomerular Diseases Associated with Paraproteinemias

Clin J Am Soc Nephrol. 2016 Dec 7;11(12):2260-2272. doi: 10.2215/CJN.02980316. Epub 2016 Aug 15.

Abstract

Paraproteins are monoclonal Igs that accumulate in blood as a result of abnormal excess production. These circulating proteins cause a diversity of kidney disorders that are increasingly being comanaged by nephrologists. In this review, we discuss paraprotein-related diseases that affect the glomerulus. We provide a broad overview of diseases characterized by nonorganized deposits, such as monoclonal Ig deposition disease (MIDD), proliferative GN with monoclonal Ig deposits (PGNMID), and C3 glomerulopathy, as well as those characterized by organized deposits, such as amyloidosis, immunotactoid glomerulopathy, fibrillary GN, and cryoglobulinemic GN, and rarer disorders, such as monoclonal crystalline glomerulopathies, paraprotein-related thrombotic microangiopathies, and membranous-like glomerulopathy with masked IgGκ deposits. This review will provide the nephrologist with an up to date understanding of these entities and highlight the areas of deficit in evidence and future lines of research.

Keywords: Amyloidosis; Immunoglobulin G; Kidney Glomerulus; Paraproteinemias; Paraproteins; Thrombotic Microangiopathies; amyloidosis; cancer; cryoglobulinemia; fibrillary glomerulonephritis; glomerular disease; glomerulonephritis; immunotactoid glomerulopathy; light chain deposition disease; multiple myeloma; nephrotic syndrome.

Publication types

  • Review

MeSH terms

  • Amyloidosis / complications*
  • Amyloidosis / drug therapy
  • Cryoglobulinemia / complications
  • Glomerulonephritis / immunology
  • Glomerulonephritis / pathology
  • Glomerulonephritis, Membranoproliferative / immunology
  • Glomerulonephritis, Membranoproliferative / pathology
  • Glomerulonephritis, Membranous / immunology
  • Humans
  • Immunoglobulin G / metabolism
  • Immunoglobulin Heavy Chains / metabolism
  • Immunoglobulin Light Chains / metabolism
  • Kidney Diseases / drug therapy
  • Kidney Diseases / immunology*
  • Kidney Diseases / pathology*
  • Kidney Glomerulus*
  • Paraproteinemias / complications*
  • Paraproteins / metabolism*
  • Thrombotic Microangiopathies / complications

Substances

  • Immunoglobulin G
  • Immunoglobulin Heavy Chains
  • Immunoglobulin Light Chains
  • Paraproteins

Supplementary concepts

  • Glomerulopathy with Giant Fibrillar Deposits