The clone wars: Diagnosing and treating dysproteinemic kidney disease in the modern era

Abstract

Dysproteinemic kidney diseases are disorders that occur as the result of lymphoprolifer-ative (B cell or plasma cell) disorders that cause kidney damage via production of nephrotoxic mon-oclonal immunoglobulins or their components. These monoclonal immunoglobulins have individ-ual physiochemical characteristics that confer specific nephrotoxic properties. There has been increased recognition and revised characterization of these disorders in the last decade, and in some cases, there have been substantial advances in disease understanding and treatments, which has translated to improved patient outcomes. These disorders still present challenges to nephrologists and patients, since they are rare, and the field of hematology is rapidly changing with the introduc-tion of novel testing and treatment strategies. In this review, we will discuss the clinical presenta-tion, kidney biopsy features, hematologic characteristics and treatment of dysproteinemic kidney diseases.