| Objective:By analyzing a series of clinical data and pathological findings,we made a summary about the clinical features and pathological features of renal biopsy patients with MGRS and explored the possible risk factors of renal dysfunction in patients with MGRS,hoping to increase our acknowledge of disease and achieve early diagnosis in patients with MGRS.Methods:Retrospective analysis was conducted on the clinical data and pathological findings of 43 patients with Monoclonal Gammopathy of Renal Significance(MGRS),and each patient has undergone pathological biopsy of kidney and bone marrow in the Department of Nephrepathy,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology(HUST).Basic data of the patients were collected,including laboratory examination and pathological data.Groups were divided based on pathological types,and statistical methods such as t test,rank sum test,Fisher’s exact probability method were performed to summarize the the spectrum of renal pathological types,clinical manifestations of MGRS and explore the possible risk factors of renal insufficiency.Results:Among the 43 MGRS patients,the male and female ratio was 1.4:1,accounting for 0.4%(43/10991)of all renal biopsy patients in wuhan union hospital during the same period.There were 36 cases(83.7%)with amyloidosis and 7 cases(16.3%)with monoclonal immunoglobulin deposition disease group(MIDD).Most patients beganwith edema,accounting for 90.7%.As far as manifestations are concerned,in the AMY,patients are older with longer disease course and hypoalbuminemia is more remarkable than in the MIDD in which anemia is more common,and the difference was statistically significant(P < 0.05).In terms of laboratory examination,the positive rate of serum immunoglobulin electrophoresis in the AMY group is higher than that in the MIDD group while the serum κ/λ ratio in the MIDD was higher than that in the AMY,with statistically significant difference(P < 0.05).In terms of pathological biopsy of the kidney,immunoglobulin deposition of AMY group was mostly composed of λ light chain,and renal microvascular wall was significantly thickened while immunoglobulin deposition of MIDD group was mostly composed of κ light chain and C3,and the difference was statistically significant(P<0.05).5 cases have been performed IgG subclass tests,of which 3 cases were positive(60%)for IgG3 subclass,while serum immunoglobulin were negative.2cases of them were negative for urinary immunoglobulin,1 case not detected.Renal insufficiency was defined as serum creatinine > 133umol/L.Based on logistic regression analysis showed that hyperuricemia was an independent risk factors for renal damage in MGRS.Conclusions:MGRS is a rare disease with diverse pathological manifestations,and renal biopsy is an important means to determine the diagnosis and pathological types of MGRS.The pathological types of patients are mainly comprised of AMY,MIDD,among which AMY is the most common type.In AMY,Other organs could be involved with various manifestations and renal pathological biopsy suggests serious vascular lesions.In terms of renal pathological immunofluorescence,it is characterized by immunoglobulin deposition which is mainly composed of λ light chain in AMY.As for MIDD,immunoglobulins deposition are mainly composed of κlight chain and C3 in which the IgG3 subclass is the most common,when the heavychain is composed of IgG.But in serum and urine immunoelectrophoresis,monoclonal immunoglobulin is generally not detected.Moreover,hyperuricemia is an independent risk factor for renal damage in MGRS. |
