Long term outcomes in monoclonal gammopathy of renal significance
Corresponding Author
Akhil Khera
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, UK
Correspondence: Akhil Khera, Department of Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7LE, UK.
E-mail: [email protected]
Search for more papers by this authorFotios Panitsas
Department of Hematology, Larissa University Hospital, Larissa, UK
Search for more papers by this authorFaouzi Djebbari
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, UK
Search for more papers by this authorKatja Kimberger
Department of Nephrology, Royal Berkshire NHS Foundation Trust, Reading, UK
Search for more papers by this authorSimon Stern
Department of Haematology, Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
Search for more papers by this authorJohn Quinn
Department of Haematology, Beaumont Hospital, Dublin, Ireland
Search for more papers by this authorNeil Rabin
Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
Search for more papers by this authorJaimal Kothari
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, UK
NIHR BRC Blood Theme, Oxford, UK
Search for more papers by this authorBassam Alchi
Department of Nephrology, Royal Berkshire NHS Foundation Trust, Reading, UK
Search for more papers by this authorRichard Haynes
Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, UK
Search for more papers by this authorChristopher Winearls
Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, UK
Search for more papers by this authorIan Roberts
Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorKarthik Ramasamy
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, UK
NIHR BRC Blood Theme, Oxford, UK
Search for more papers by this authorCorresponding Author
Akhil Khera
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, UK
Correspondence: Akhil Khera, Department of Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7LE, UK.
E-mail: [email protected]
Search for more papers by this authorFotios Panitsas
Department of Hematology, Larissa University Hospital, Larissa, UK
Search for more papers by this authorFaouzi Djebbari
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, UK
Search for more papers by this authorKatja Kimberger
Department of Nephrology, Royal Berkshire NHS Foundation Trust, Reading, UK
Search for more papers by this authorSimon Stern
Department of Haematology, Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
Search for more papers by this authorJohn Quinn
Department of Haematology, Beaumont Hospital, Dublin, Ireland
Search for more papers by this authorNeil Rabin
Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
Search for more papers by this authorJaimal Kothari
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, UK
NIHR BRC Blood Theme, Oxford, UK
Search for more papers by this authorBassam Alchi
Department of Nephrology, Royal Berkshire NHS Foundation Trust, Reading, UK
Search for more papers by this authorRichard Haynes
Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, UK
Search for more papers by this authorChristopher Winearls
Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, UK
Search for more papers by this authorIan Roberts
Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Search for more papers by this authorKarthik Ramasamy
Department of Haematology, Oxford University Hospitals NHS Foundation Trust, UK
NIHR BRC Blood Theme, Oxford, UK
Search for more papers by this author[Correction added on 20 June 2019, after online publication: The author’s (Bassam Alchi) affiliation was previously incorrect and has been updated in this version]
Summary
Unlike AL amyloid and cast nephropathy, the long-term outcomes of monoclonal gammopathy of renal significance (MGRS) patients with other renal histopathologies remain unclear. It is uncertain if early intervention improves renal outcomes, because of a lack of evidence from prospective studies. In this retrospective study, we examined outcomes of 41 MGRS patients treated between 2004 and 2017 across five centres: four in the UK and one in the Republic of Ireland. The primary outcome measure was renal survival estimated by Kaplan–Meier product-limit method. Thirty-three patients (80·5%) were kappa light chain (LC) restricted. Twenty-seven patients (65·9%) presented with LC deposition disease on renal histology. At 24 months follow-up, estimated renal survival was 81·6% for the whole cohort. The estimated overall survival was 80·3% at 48 months. At 24 months, patients who had chronic kidney disease (CKD) stage 2–3b at diagnosis showed an estimated renal survival of 100% compared to 80·7% in those with CKD stage 4–5 at diagnosis (P = 0·04). Poorer outcomes in MGRS patients were historically attributed to delayed diagnosis due to small plasma cell clones, as well as the need for renal biopsy.
Conflicts of interests
The authors have no competing interests to declare.
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