MONOCLONAL GAMMOPATHY OF RENAL SIGNIFICANCE: A LOOK AT THE CURRENT

Abstract

Introduction: Monoclonal gammopathy of renal significance comprises a spectrum of renal diseases caused by nephrotoxic monoclonal immunoglobulins, secreted by B clones or plasma cells with low tumor burden, which do not meet the diagnostic criteria for hematological neoplasms. Although these clones do not constitute classic malignancies, they have a high capacity to promote clinically significant renal lesions. Objective: To conduct a narrative review of the literature on monoclonal gammopathy of renal significance with emphasis on its pathophysiological mechanisms, histopathological classification, diagnostic approach, and emerging therapeutic strategies. Methods: A literature review was conducted in the PubMed and SciELO databases, covering publications from the last ten years. Systematic review articles, international clinical guidelines, and original studies with relevance to nephrological practice were prioritized. Results: Monoclonal gammopathy of renal significance includes a variety of renal lesions, such as glomerulopathies associated with monoclonal immunoglobulins, tubulointerstitial lesions, and vascular impairments. Renal biopsy remains the gold standard for diagnosis, being essential for defining the histopathological pattern and for therapeutic stratification. The treatment aims at the eradication of the producer clone, using therapies inspired by the protocols of multiple myeloma and B-cell lymphomas, with emphasis on proteasome inhibitors and monoclonal antibodies. Growing evidence indicates that early intervention with clone-directed therapies is associated with stabilization or improvement of renal function. Discussion: Monoclonal gammopathy of renal significance represents an entity of increasing clinical relevance, whose evolution can culminate in end-stage chronic kidney disease. Early recognition of the condition, coupled with a multidisciplinary approach involving nephrologists and hematologists, is key to mitigating progressive kidney damage. The absence of established hematologic malignancy does not exclude the need for aggressive treatment, in view of the nephrotoxic impact of monoclonal immunoglobulins.

DOI: https://doi.org/10.56238/sevened2025.009-003