Table 3 Renal lesions associated with monoclonal gammopathy

Lesion	Proportion of lesions (%)
Lesion	Monoclonal immunoglobulin deposits	Detectable monoclonal immunoglobulin	MM	MGRS	Other^a	Refs
Light-chain cast nephropathy	100	100	99	0	~1	^2,4,11,13
Immunoglobulin-related amyloid amyloidosis	96	99	16	80	1–4	^{43,113,128,129}
MIDD	100	100	0–20	78–100	1–2	^{29,31,68,130,131}
Light-chain proximal tubulopathy	100	97^b	12–33	61–80	3–8	^32,56,58,132
Cryoglobulinaemic (type I) glomerulonephritis	100	90–100	6–8	47–52	24–56	^{133,134,135,136}
Cryoglobulinaemic (type II) glomerulonephritis	100	49	0	20	7	^{133,134,135,136}
PGNMID	100	30–32	4	96	~1	^24,72
Crystal-storing histiocytosis	83	90	33	8	50	¹³⁷
Cryocrystalglobulin or crystalglobulin nephropathy	91	82	61	18	4	¹³⁸
Immunotactoid glomerulonephritis	69–93	63–71	0–13	25–50	25–50	^23,51
C3 glomerulopathy with monoclonal gammopathy^c	0	28–83^d	0–40^d	40–90	6–10	^25,74,75,104
Monoclonal fibrillary glomerulonephritis^e	100	7–17	0–54	55–98	2–10	^44,47,139

MGRS, monoclonal gammopathy of renal significance; MIDD, monoclonal immunoglobulin deposition disease; MM, multiple myeloma; PGNMID, proliferative glomerulonephritis with monoclonal immunoglobulin deposits. ^aHaematological conditions including lymphoplasmacytic lymphoma (Waldenström macroglobulinaemia), smouldering Waldenström macroglobulinaemia, B cell lymphomas, chronic lymphocytic lymphoma and monoclonal B cell lymphocytosis. ^bSensitivity increased by immunofluorescence after pronase digestion. ^cMost instances of fibrillary glomerulonephritis and C3 glomerulopathy are not associated with a monoclonal gammopathy. The percentages for MM, MGRS and other haematological conditions relate to the group of patients who do have a monoclonal gammopathy. ^dPatients over the age of 50 years. ^eIn these patients, the glomerular deposits show light-chain restriction or stain for IgG without light chains, both by frozen tissue and paraffin tissue immunofluorescence (as in 15–17% of patients with fibrillary glomerulonephritis).

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