Clinical Case 63: Answers and Summary

MGUS HAS NOW SOME SIGNIFICANCE IN THE KIDNEY AND MONOCLONAL GAMMOPATHY OF RENAL SIGNIFICANCE(MGRS) IS EMERGING. REGARDING THE NATURAL HISTORY OF MGUS, WHICH OF THESE STATEMENTS ARE TRUE?( CLICK ALL THAT APPLY)

1.Approximately 1% of patients progress to myeloma over a year
2.Besides myeloma, MGUS can also precede the diagnosis of amylodosis or WM

3.Besides myeloma, MGUS can also precede the diagnosis of lymphoma

4.The first clinicians to identify these patients are usually hematologists

5.Over 50 years of age, close to 15% have MGUS

 Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic pre-malignant clonal plasma cell or lymphoplasmacytic proliferative disorder. MGUS occurs in over 3 percent of the general population over the age of 50. Besides myeloma, MGUS can also precede the diagnosis of amylodosis or WM and the diagnosis of lymphoma. Approximately 1% of patients progress to myeloma over a year.  This is usually picked up by non hematologist initially and then referred for bone marrow examination. Usually, nephrologists are one of the early diagnostician of this entity. The following signs or symptoms should be considered ‘red flags’ that necessitate further investigation: bone pain,generalized weakness, neuropathy, headache, macroglossia, nephrotic range proteinuria, lymphadenopathy, anemia, elevated creatinine, hypercalcemia. MGUS associated with renal disease such as proliferative GN, MPGN has now some terminology such as MGRS or monoclonal gammopathy of renal significance.

A nice review article is http://www.ncbi.nlm.nih.gov/pubmed/22920639