MGRS: We need to think a new way!

Many times we have come across monoclonal deposition in the kidney of Ig and there is no bone marrow or blood findings to suggest malignancy.  Lately, there has been findings of association of many such instances with glomerular diseases:

1. MGUS with MPGN
2. New findings of proliferative GN with monoclonal deposits( but no real bone marrow findings)
3. Immunotactoid GN and its's perhaps relationship with CLL and monoclonality
4. Fibrillary GN and similar findings ( less often than immunotactoid GN)
5. LCDD but no BM findings fully suggestive of >10% plasma cells to make a Myeloma diagnosis.

Clearly, there is monoclonal gammopathy of RENAL significance(MGRS) in all above states and perhaps we need to re look at a group of these disease states more carefully. Unfortunately, no studies exist to tell us how to treat them. Do we treat them as denovo renal diseases or treat the underlying plasma cell or B cell clone?

Some recent articles are worth a read to perhaps start some thought provoking discussions re these associations.