Chapter

Kidney involvement in plasma cell dyscrasias

Pierre M. Ronco

in Oxford Textbook of Clinical Nephrology

Fourth edition

Published on behalf of Oxford University Press

Published in print October 2015 | ISBN: 9780199592548
Published online October 2015 | e-ISBN: 9780191779145 | DOI: http://dx.doi.org/10.1093/med/9780199592548.003.0150

Series: Oxford Textbook

Kidney involvement in plasma cell dyscrasias

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Monoclonal proliferations of the B-cell lineage are characterized by abnormal and uncontrolled expansion of a single clone of B cells at different maturation stages, with a variable degree of differentiation to immunoglobulin-secreting plasma cells. Therefore, they are usually associated with the production and secretion in blood of a monoclonal immunoglobulin and/or a fragment thereof which may become deposited in tissues. These deposits can take the form of casts (in myeloma cast nephropathy), crystals (in myeloma-associated Fanconi syndrome), fibrils (in light-chain and exceptional heavy-chain amyloidosis), or granular precipitates (in monoclonal immunoglobulin deposition disease). They may disrupt organ structure and function, inducing life-threatening complications. All of the pathologic entities related to immunoglobulin deposition principally involve the kidney, which is not only explained by the high levels of renal plasma flow and glomerular filtration rate, but also by the sieving properties of the glomerular capillary wall and by the prominent role of the renal tubule in LC handling and catabolism.

The different renal (and other) manifestations are related to the unique physicochemical characteristics of each paraprotein or immunoglobulin fragment, and the rate of their production.

Chapter.  2559 words. 

Subjects: Nephrology ; Surgery

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