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S e p t e m b e r 2 0 - 2 1 , 2 0 1 8 | R o m e , I t a l y

Joint Event on

OF EXCELLENCE

IN INTERNATIONAL

MEETINGS

YEARS

Dermatology Congress 2018 & World Nephrology 2018

Archives of General Internal Medicine

ISSN: 2591-7951

Volume 2

WORLD NEPHROLOGY AND THERAPEUTICS CONGRESS

DERMATOLOGY AND TRICHOLOGY

International Congress on

Arch Gen Intern Med 2018, Volume 2 | DOI: 10.4066/2591-7951-C5-015

MONOCLONAL GAMMOPATHY OF RENAL SIGNIFICANCE: CASE REPORT

Fonseca GS

, Monteiro MLGR

, Zago L

, Machado JR

and

Reis MA

Federal University of Triângulo Mineiro, Brazil

Federal University of Goiás, Brazil

Introduction:

The term monoclonal gammopathy of renal significance (MGRS) was proposed by the International Kidney and

Monoclonal Gammopathy Research Group in 2012 to designate the deposition of monoclonal proteins in the kidney with organ

damage. Renal biopsy is fundamental for the investigation as it identifies the presence and pattern of renal monoclonal deposits

- whether organized or not.

Case report:

This is thecaseof a77-year-oldwoman, hospitalized inFebruary2017due toprogressivelyworsening renal insufficiency

lasting for a year, nephrotic syndrome and with indication of renal replacement therapy. Besides renal condition, she presented

bicytopenia (anemia and thrombocytopenia) and despite negative serum protein electrophoresis and negative immunofixation of

serum proteins, the immunofixation of urinary proteins showed a pattern suggestive of IgG/Kappa restriction. Considering the

possibility of adisease in the spectrumofmonoclonal gammopathies, amyelogramwasperformedwitha representative sampleand

showed no evidence of plasma cell infiltration (which excluded multiple myeloma). Renal biopsy revealed a membranoproliferative

patternwith subendothelial deposits of IgG, Kappa, Lambda, C3 and C1q in glomeruli. Electronmicroscopy evidencedmesangial and

subendothelial fibrillary deposits. Thus, the association of clinical-laboratorial and morphological data made the MGRS diagnosis

possible. However, there was no benefit in initiating chemotherapy as it was already an end-stage renal disease.

Conclusion:

Renal biopsy is mandatory for the diagnostic definition of this recently described entity, characterized by renal

deposition of monoclonal proteins originating from clones of small B-cells, and has therapeutic implications.