肾意义的单克隆免疫球蛋白血症病例报道并文献复习

Clinical Diagnosis and Treatment of Monoclonal Gammopathy of Renal Significance

肾意义的单克隆免疫球蛋白血症(MGRS)是由低级别淋巴浆细胞增殖性疾病分泌的单克隆免疫球蛋白(Ig)介导的肾损害,为疾病早期阶段,尚不足以诊断为多发性骨髓瘤(MM)或淋巴瘤。本文分析了2018年3月-2020年2月首都医科大学附属北京朝阳医院西院血液科收治的1例MM合并肾损害和3例不同类型的MGRS患者的临床特点及诊治过程,对其肾损害进行了鉴别诊断,并结合病例和文献进行了系统分析。建议对表达浆细胞克隆或B淋巴细胞克隆的患者分别采用硼替佐米或利妥昔单抗为基础的治疗方案,提示临床医生对存在单克隆Ig和无法解释的肾脏疾病患者,需早期进行肾活检以确诊MGRS,遵循国际肾病和单克隆免疫球蛋白病研究组(IKMG)提出的诊断共识和诊断流程,进一步明确MGRS的诊断分型,有利于早期进行克隆指导的靶向治疗,改善患者的肾功能和预后。

Monoclonal gammopathy of renal significance(MGRS)is a kind of renal damage mediated by monoclonal immunoglobulin(Ig)secreted by low-grade lymphoplasmacytic proliferative diseases.It is an early stage of the disease and is not enough to diagnose multiple myeloma(MM)or lymphoma.This paper analyzed the clinical characteristics,diagnosis and treatment process with a differential diagnosis of renal damage of 1 case of MM with renal damage and 3 cases of different types of MGRS admitted to Department of Hematology,West Hospital of Beijing Chao-yang Hospital from March 2018 to February 2020.Following that,a systematic review was conducted based on the case report and related literature,and recommendations were obtained,such as bortezomib-based option is recommended for patients with abnormal plasma cell clone and rituximab-based option is recommended for those with abnormal proliferation of B lymphocyte clone.It is suggested that for a patient with monoclonal Ig or unexplained renal disease,early renal biopsy is needed to confirm whether he has MGRS.If MGRS is confirmed,then its classification should be determined following the diagnosis consensus and process proposed by the International Kidney and Monoclonal Gammopathy Research Group,which will contribute to early delivery of clone-directed targeted therapy,thereby improving the renal function and prognosis of the patient.