Monoclonal Gammopathy of Renal Significance: Hematologic Perspective | Heather Landau, MD

Hi, my name is Heather Landau from Memorial Sloan Kettering Cancer Center and I'm delighted to share with you some information on the topic of monoclonal gammopathy of renal significance from a hematologic perspective. So monoclonal gammopathy of renal significance or what we call MGRS is a group of disorders that result from either a underlying B cell clone or a plasma cell clone that generates a monoclonal immunoglobulin and that immunoglobulin causes kidney damage directly from either the monoclonal gammopathy or an ancillary mechanism prompted by the monoclonal gammopathy. And so patients present in a very heterogeneous way with typically with proteinuria or elevated creatinine or microscopic blood in the urine or hypertension that comes out of the blue and patients with any of those symptoms and a monoclonal gammopathy really need to be for this entity and because it was in the past not recognized as something that was treatable we now have termed this monoclonal gammopathy of renal significance because we know if we treat the disease or the underlying clonal disease that we can improve patients outcomes in terms of their kidney survival and kidney survival meaning their time to their risk for developing dialysis dependent renal failure. So anybody who has a protein loss or an elevated creatinine or again new onset hypertension or microscopic hematuria should be evaluated for this entity and that requires both blood and urine tests specifically serum protein electrophoresis, immunofixation, urine protein electrophoresis, immunofixation, quantitative amount of protein in the urine so that usually requires a 24 hour urine specimen as well as a kidney biopsy in the majority of cases and a bone marrow evaluation and the good news is if we find a clone we can typically treat the clone there's not a whole lot of data on the best ways to manage this with the exception of ALM leidosis has a real clear upfront management strategy that's well vetted. The other treatments for either a B cell clone or other plasma cell clones are really just borrowed from what we know about treating B cell clones or plasma cell clones but the good news is that we can treat these diseases if we recognize them and even if the kidneys do fail if we can get the patients into a hematologic remission we can often perform kidney transplantation for patients who have develop end stage renal disease or dialysis dependent renal disease due to one of these entities and I'm a big proponent of really allowing patients with this diagnosis to be considered for a kidney transplantation because patients can do quite well. Thank you very much. If our videos have helped you in any way and you're able to please consider making a donation to help us continue this important work. Your gift will go three times as far when we reach five hundred thousand dollars by the end of the year. Every contribution big or small makes a difference and we're deeply grateful for your support.