A clone-directed approach may improve diagnosis and treatment of proliferative glomerulonephritis with monoclonal immunoglobulin deposits

Kidney International
Ramnika GumberJonathan J Hogan

Abstract

The optimal treatment for the monoclonal gammopathies of renal significance is not known, but there is consensus among experts that treatment should be specific for the underlying clone. The majority of patients with proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) do not have an identifiable clone, and prior studies have found poor renal outcomes for patients with PGNMID treated with a variety of regimens. Here we present a retrospective case series of 19 patients with PGNMID with a more uniform, clone-directed approach. A circulating paraprotein was detected in 37% of patients, and the overall clone detection rate was 32%. Treatment was directed at the underlying clone or, for patients without a detectable clone, empirically prescribed to target the hypothesized underlying clone. Of the 16 patients who underwent treatment, the overall renal response rate was 88%, and 38% of patients experienced complete renal response (proteinuria reduction to under 0.5 gm/24 hours) with initial treatment. All patients were End Stage Renal Disease-free at last follow-up (median 693 days after diagnosis), and treatment was well tolerated. Thus, a clone-directed approach may lead to novel, targeted treatment str...Continue Reading

Citations

May 20, 2018·Clinical Journal of the American Society of Nephrology : CJASN·Jonathan J Hogan
Sep 1, 2018·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Krzysztof BatkoKatarzyna Krzanowska
Aug 15, 2019·Blood Advances·Ankur JainKarthik Ramasamy
Aug 28, 2020·CA: a Cancer Journal for Clinicians·Mitchell H RosnerMark A Perazella
Oct 13, 2020·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Paul MillerMegan L Troxell
Jan 3, 2021·International Urology and Nephrology·Hui Zhuan TanCiwei Cynthia Lim
Jan 30, 2021·Kidney International·Jonathan J Hogan, Dan T Vogl
Jan 26, 2021·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Frank BridouxNelson Leung
Dec 10, 2020·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·David W ChittyVinay Nair
Mar 10, 2021·Journal of the American Society of Nephrology : JASN·Ladan ZandFernando C Fervenza
Mar 24, 2021·Critical Care Clinics·Jaya Kala, Kevin W Finkel
Apr 1, 2021·Nature Reviews. Nephrology·Frank BridouxNelson Leung
Oct 26, 2020·Hematology/oncology Clinics of North America·Sascha A Tuchman, Jeffrey A Zonder
May 1, 2021·Journal of Clinical Medicine·Rupali S AvasareJonathan J Hogan
May 20, 2021·The New England Journal of Medicine·Nelson LeungSamih H Nasr
Jun 28, 2021·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Cihan HeybeliNelson Leung
Jul 5, 2021·European Journal of Medical Research·Xuanli TangBin Zhu

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.