Microclassroom Issue 8 Prof. Jiang Hua: Definition, Mechanism, Diagnosis and Treatment of MGRS

There are many types of monoclonal immunoglobulin-related diseases, often involving the kidneys, heart and other organs

The mechanism of renal damage in MGRS is very complex.

Figure 1 Mechanism of MGRS kidney damage

Most MGRS require pathological diagnosis and identification of renal biopsy

^{In 2019, the MGRS Consensus Report 2} published by the International Kidney and Monoclonal Gammopathy Study Group (IKMG) proposed a recommended diagnostic process: for patients suspected of MGRS or diagnosed with MGUS, renal function tests are required before treatment.

After a clear diagnosis, targeted treatment should be carried out for patients with MGRS, and the treatment should follow the following principles: the main purpose of MGRS treatment is to protect renal function, and a balance between treatment toxicity and potential benefits should be achieved during treatment; for advanced chronic kidney disease ( CKD), the purpose of clonal targeted therapy should be shifted to reducing the risk of MGRS recurrence after kidney transplantation; for advanced CKD patients who are not suitable for transplantation, the pros and cons of the treatment should be balanced, and only when there is extrarenal involvement or malignant tumors.

At present, except for AL amyloidosis, there are no relevant guidelines for the treatment of other types of MGRS

^{In recent years} , the CD38 monoclonal antibody-daratumumab has also published many important research data in the field of amyloidosis .

Figure 2 Results of organ remission in each subgroup of the ANDROMEDA study

Summarize 

MGRS, monoclonal immunoglobulinopathies of renal significance, are a group of clonal disorders of B cells or plasma cells that cause renal damage through the production of monoclonal immunoglobulins

MGRS differentiates different types according to monoclonal immunoglobulin types and their deposition sites

The diagnosis of MGRS needs to be evaluated from the two aspects of hematology and renal involvement

Renal biopsy should be performed in all patients with suspected MGRS

The main purpose of MGRS treatment is to protect renal function, and the treatment plan should be considered from two aspects of renal disease treatment and anti-B cell cloning therapy.

[1] Nelson Leung, et al.
N Engl J Med.
2021 May 20;384(20):1931-41.

[2] Leung N, et al.
Nat Rev Nephrol.
2019 Jan;15(1):45-59.

[3] Fermand JP, et al.
Blood.
2013 Nov 21;122(22):3583-90.

[4] Efstathios Kastritis, et al.
2021ASCO.

[5]Raymond Comenzo, et al.
2021ASH.
Abstract Oral 159.

MED-DAR-CN-0774 Content Approved Date: 8/11/2022

For reference only by medical and pharmaceutical professionals, reproduction and dissemination are strictly prohibited

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