GLOMERULAR MONOCLONAL GAMMOPATHIES IN WESTERN AUSTRALIA, STATE-WIDE 5-YEAR RETROSPECTIVE ANALYSIS
Dr Awf Abdulrahman Shaban1,2, Dr Hun Chuah1,3, Prof Michael Leahy1,3
1Royal Perth Hospital, Perth, Australia, 2Curtin Medical School, Perth, Australia , 3School of Pharmacology and Medicine, University of Western Australia, Perth, Australia
Background: Monoclonal gammopathies of renal significance (MGRS) have emerged as an important cause of kidney injury. MGRS needs careful attention because without prompt diagnosis and timely intervention, the patients have significantly high risk of progression to haematological malignancies and/or end-stage kidney disease (ESKD).
Aim: The study aimed to evaluate the renal and haematological outcomes of patients with glomerular monoclonal gammopathies in Western Australia.
Methods: All patients with glomerular pathologies secondary to monoclonal gammopathies identified retrospectively in native renal biopsies evaluated at the state-wide renal pathology units, PathWest Laboratory Medicine, from 01.01.2019-31.12.2023. Inclusion: All patients that fulfilled the diagnostic criteria for glomerular MGRS. Exclusion: Non-glomerular MGRS, lack of tissue for immunofluorescence, and presence of concurrent diagnosis that could affect the outcome.
Results: We identified 45 patients with glomerular monoclonal gammopathies, with mean age of 66 years (SD12), and 28 (62%) being male. The cohort included 25 patients (56%) with AL amyloidosis, 9 patients (20%) with Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposition (PGNMID), 6 patients (13%) with Monoclonal Immunoglobulin Deposition Disease (MIDD), and 3 patients (6%) with Cryoglobulinaemic Glomerulonephritis.
With a median follow up of 43.5 months, 8 patients (18%) progressed to ESKD. All-cause mortality was 27% (12 patients). Median eGFR at time of diagnosis was 55 (IQR 53) ml/min/1.73m2 with median of 39 (IQR 31) ml/min/1.73m2 at 12-months. Bortezomib based therapy was the commonest therapy (49%), followed by autologous stem cell transplant (22%). Daratumumab based therapy was used in 20% of the patients.
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Biography:
Awf is dual trainee in Nephrology and General Medicine, with special interest in glomerular diseases, particularly haematological induced renal disorders.