Observational studyJournal of nephrology2025
Monoclonal gammopathy is present in one fourth of patients undergoing renal biopsy but is pathogenic only in half of them.
Observational study in Journal of nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Noncrystalline light-chain proximal tubulopathy: a retrospective study from a single institute of China.Renal failure · 2026Article
- Light chain-mediated acute tubulointerstitial nephritis as the sole manifestation of monoclonal gammopathy of renal significance in a young adult.BMJ case reports · 2026Article
- Machine Learning for Monoclonal Gammopathies of Renal Significance Risk Stratification Using Clinical and Pathology Data.Kidney international reports · 2025Article
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5 authors.
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Abstract
backgroundAbout 4-7% of renal biopsies show a monoclonal gammopathy-related nephropathy, such as AL amyloidosis, cast nephropathy, or light chain deposition disease. Both a high prevalence and a causal role of monoclonal gammopathy have been observed in patients with C3 glomerulopathy or thrombotic microangiopathy, although a definitive causative role cannot be established in most cases (potentially monoclonal gammopathy-related nephropathies). A coexisting monoclonal gammopathy has been identified in many cases of nephropathy without a defined causative role (monoclonal gammopathy-unrelated nephropathies). The aim of this study was to investigate the prevalence and distribution of monoclonal gammopathy in patients who underwent a renal biopsy and assess its possible causal role in nephropathies not ordinarily related to monoclonal gammopathy.
methodsIn our single-center retrospective observational study, we considered patients who underwent native kidney biopsy from 2009 to 2023 at the Nephrology Unit, Careggi University Hospital, Florence (Italy) and for whom a complete monoclonal gammopathy workup (serum electrophoresis, serum and urinary immunofixation, serum free light chains) was available.
resultsOverall, 827 patients were included: 208 (25%) had a monoclonal gammopathy: in 104 cases the monoclonal gammopathy was unrelated to the kidney disease; 87 subjects showed renal pathology related to monoclonal gammopathy (monoclonal gammopathy-related nephropathies). Patients with thrombotic microangiopathy and C3 glomerulopathy (potentially monoclonal gammopathy-related nephropathies) exhibited a prevalence of monoclonal gammopathy > 30%. In a subgroup of diagnoses (e.g. tubulointerstitial nephritis, membranoproliferative glomerulonephritis) a possible causal and/or prognostic role of a concomitant monoclonal gammopathy may be hypothesized.
conclusionsIn our cohort, one fourth of patients undergoing a renal biopsy had a monoclonal gammopathy, although in half of them the monoclonal gammopathy did not have a causative role in the kidney disease. Hence, it is impossible to conclude that a monoclonal gammopathy in the context of renal disease equates to a causal association without performing a renal biopsy because of the high frequency of monoclonal gammopathy in patients undergoing a kidney biopsy.
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