Bortezomib maintenance for the treatment of Monoclonal Gammopathy of Renal Significance

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Holly Lee
Peter Duggan
Ernesta Paola Neri
Jason Tay
Victor Jimenez Zepeda



Monoclonal gammopathy of renal significance (MGRS) defines renal disease resulting from monoclonal proteins that are secreted from clonal B cells, that does not meet criteria for lymphoma or multiple myeloma. Recognizing MGRS in clinical practice is important because renal outcomes are poor and treatments targeting the underlying clonal disease have been associated with improved renal survival. In this case report, we present a case of a patient with membranoproliferative glomerulonephritis (MPGN) with IgG-kappa deposition who underwent clone directed treatment in a phased approach with induction and maintenance to achieve renal response. This is one of the first cases to report on MGRS treatment that required extended maintenance therapy.


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1. Leung, N., F. Bridoux, C.A. Hutchison, S.H. Nasr, P. Cockwell, J.P. Fermand, A. Dispenzieri, K.W. Song, and R.A. Kyle. Monoclonal gammopathy of renal significance: when MGUS is no longer undetermined or insignificant. Blood, 2012; 120(22): p. 4292-5. Retrieved from
2. Leung, N., M.E. Drosou, and S.H. Nasr. Dysproteinemias and Glomerular Disease. Clin J Am Soc Nephrol, 2018; 13(1): p. 128-139. Retrieved from
3. Al-Hussain, T., M.H. Hussein, H. Al Mana, and M. Akhtar. Renal involvement in monoclonal gammopathy. Adv Anat Pathol, 2015; 22(2): p. 121-34. Retrieved from
4. Nasr, S.H., A. Satoskar, G.S. Markowitz, A.M. Valeri, G.B. Appel, M.B. Stokes, T. Nadasdy, and V.D. D'Agati. Proliferative glomerulonephritis with monoclonal IgG deposits. J Am Soc Nephrol, 2009; 20(9): p. 2055-64. Retrieved from
5. Fermand, J.P., F. Bridoux, R.A. Kyle, E. Kastritis, B.M. Weiss, M.A. Cook, M.T. Drayson, A. Dispenzieri, and N. Leung. How I treat monoclonal gammopathy of renal significance (MGRS). Blood, 2013; 122(22): p. 3583-90. Retrieved from
6. Palladini, G., A. Dispenzieri, M.A. Gertz, S. Kumar, A. Wechalekar, P.N. Hawkins, S. Schonland, U. Hegenbart, R. Comenzo, E. Kastritis, M.A. Dimopoulos, A. Jaccard, C. Klersy, and G. Merlini. New criteria for response to treatment in immunoglobulin light chain amyloidosis based on free light chain measurement and cardiac biomarkers: impact on survival outcomes. J Clin Oncol, 2012; 30(36): p. 4541-9. Retrieved from
7. Radhakrishnan, J. and D.C. Cattran. The KDIGO practice guideline on glomerulonephritis: reading between the (guide)lines--application to the individual patient. Kidney Int, 2012; 82(8): p. 840-56. Retrieved from
8. Nasr, S.H., G.S. Markowitz, M.B. Stokes, S.V. Seshan, E. Valderrama, G.B. Appel, P. Aucouturier, and V.D. D'Agati. Proliferative glomerulonephritis with monoclonal IgG deposits: a distinct entity mimicking immune-complex glomerulonephritis. Kidney Int, 2004; 65(1): p. 85-96. Retrieved from
9. Nasr, S.H., S. Sethi, L.D. Cornell, M.E. Fidler, M. Boelkins, F.C. Fervenza, F.G. Cosio, and V.D. D'Agati. Proliferative glomerulonephritis with monoclonal IgG deposits recurs in the allograft. Clin J Am Soc Nephrol, 2011; 6(1): p. 122-32. Retrieved from
10. Lorenz, E.C., S. Sethi, N. Leung, A. Dispenzieri, F.C. Fervenza, and F.G. Cosio. Recurrent membranoproliferative glomerulonephritis after kidney transplantation. Kidney Int, 2010; 77(8): p. 721-8. Retrieved from
11. Steiner, N., G. Göbel, P. Suchecki, W. Prokop, H. Neuwirt, and E. Gunsilius. Monoclonal gammopathy of renal significance (MGRS) increases the risk for progression to multiple myeloma: an observational study of 2935 MGUS patients. Oncotarget, 2018; 9(2): p. 2344-56. Retrieved from[]=23412&path[]=73752
12. Bhutani, G., S.H. Nasr, S.M. Said, S. Sethi, F.C. Fervenza, W.G. Morice, P.J. Kurtin, F.K. Buadi, D. Dingli, A. Dispenzieri, M.A. Gertz, M.Q. Lacy, P. Kapoor, S. Kumar, R.A. Kyle, S.V. Rajkumar, and N. Leung. Hematologic characteristics of proliferative glomerulonephritides with nonorganized monoclonal immunoglobulin deposits. Mayo Clin Proc, 2015; 90(5): p. 587-96. Retrieved from
13. Chauvet, S., V. Fremeaux-Bacchi, F. Petitprez, A. Karras, L. Daniel, S. Burtey, G. Choukroun, Y. Delmas, D. Guerrot, A. Francois, M. Le Quintrec, V. Javaugue, D. Ribes, L. Vrigneaud, B. Arnulf, J.M. Goujon, P. Ronco, G. Touchard, and F. Bridoux. Treatment of B-cell disorder improves renal outcome of patients with monoclonal gammopathy-associated C3 glomerulopathy. Blood, 2017; 129(11): p. 1437-1447. Retrieved from
14. Kumar, S., S.T. Mahmood, M.Q. Lacy, A. Dispenzieri, S.R. Hayman, F.K. Buadi, D. Dingli, S.V. Rajkumar, M.R. Litzow, and M.A. Gertz. Impact of early relapse after auto-SCT for multiple myeloma. Bone Marrow Transplant, 2008; 42(6): p. 413-20. Retrieved from