Monoclonal gammopathies represent a group of related disorders characterized by a clone of plasma cells or lymphocytes with the capacity to secrete a homogeneous immunoglobulin or its components, which may be recognized as a peak on serum or urine protein electrophoresis. Monoclonal gammopathy of undetermined significance mgus is a plasma cell dyscrasia in which plasma cells or other types of antibodyproducing cells secrete a myeloma protein, i. It does not include upper motor neuron lesions, lower motor neuron lesions, myasthenia gravis which also causes muscle weakness. After hypoalbuminemia, polyclonal gammopathy is the most common protein.
The net charge positive or negative and the size and shape of the protein commonly are used in differentiating various serum proteins. Jan 11, 2018 monoclonal gammopathy of undetermined significance mgus is a premalignant, clonal plasma cell disorder, characterized by the presence of a monoclonal m protein, ppt presentation. In the publish as pdf or xps dialog box, choose a location to save the file to. An antigen mixture is first separated into its component parts by electrophoresis and then tested by double immunodiffusion. In one series, serum protein electrophoresis showed a spike or localized band in only 82 percent of patients with multiple myeloma. Monoclonal gammopathy of undetermined significance mgus is the property of its rightful owner. Differential diagnosis of monoclonal gammopathy sciencedirect. It is characterized by the presence of a high level of a macroglobulin immunoglobulin m igm, elevated serum viscosity, and the presence of a lymphoplasmacytic infiltrate in the bone marrow. They can be classified either as polyclonal increases in all major immunoglobulin classes or monoclonal increases in a single homogeneous immunoglobulin. Analysis of bcell subpopulations in monoclonal gammopathies. Monoclonal gammopathy of undetermined significance mgus is a condition in which an abnormal protein called monoclonal protein is detected in the blood. Clinical work up and treatment of monoclonal gammopathy.
The differential diagnosis of the patient with a monoclonal gammopathy can present. Understanding and interpreting serum protein electrophoresis. Pdf converter is a online webbased document to pdf converter software. Our current signouts are presented in tabular form and readers are encouraged to use them if they wish. If so, share your ppt presentation slides online with.
Gammopathies are conditions in which serum immunoglobulin levels are greatly increased. We provide a detailed phenotypic profile and enumeration of bcell subpopulations in monoclonal gammopathy patients. How i manage monoclonal gammopathy of undetermined significance. Pdf diagnosis of monoclonal gammopathy of renal significance. A 67yearold man with a recently discovered monoclonal gammopathy of unknown significance mgus presented with microscopic hematuria, nephroticrange proteinuria, and rapidly deteriorating renal function after a pneumonia. Monoclonal gammopathy of undetermined significance mgus is a premalignant, clonal plasma cell disorder, characterized by the presence of a monoclonal m protein, myeloma. Greater sensitivity, compared to urine analysis, has heralded the widespread use and incorporation of serum flc measurements into multiple guidelines for the management of myeloma, most recently as a myeloma defining event in asymptomatic patients. Plasma cell disorders may be suspected because of clinical manifestations most often bone disease, renal failure, and low blood counts, or an incidental finding of elevated serum protein or proteinuria that leads to further evaluation with serum or urine protein electrophoresis. Introduction the promise, for many years, of useful diagnostic and therapeutic monoclonal antibodies has begun to. The diseases associated with the monoclonal gammopathies at mayo clinic from. Clinical work up and treatment of monoclonal gammopathy of. Cast nephropathy monteseny 1998 nasr 2011 oshima 2001 wirk 2011 leung 2014 cast nephropathy 41 % 33 % 23. Practical approach to evaluation of monoclonal gammopathies. The clone usually consists of plasma cells when the monoclonal immunoglobulin mig is immunoglobulin g igg, iga, igd, or light chain lc only and lymphoplasmacytic when producing an igm.
Convert and create pdf from various types of files like word doc, excel xls, powerpoint ppt. The clinical relevance and management of monoclonal. Microabstractnecrobiotic xanthogranuloma is a rare chronic granulomatous disorder of the skin associated with a monoclonal gammopathy. Plasma cell dyscrasia with renal impairment including mgrs. People can view the slides even if they dont have powerpoint, but they cant make changes to it. Plasma cell neoplasms including multiple myeloma treatment. Interpreting protein electrophoresis in practice in practice. This is the best electrophoresis test to screen for monoclonal proteins in the urine. Each individual antibody in a polyclonal mixture is technically a monoclonal antibody. Dec 27, 2016 monoclonal gammopathy of undetermined significance mgus is a condition in which an abnormal protein called monoclonal protein is detected in the blood. Definitions electrophoresis is a method of separating proteins based on their physical properties. Introduction to diagnostic and therapeutic monoclonal. Page 7 of 34 introduction to diagnostic and therapeutic monoclonal antibodies blaine templar smith, r. In general, we test for the presence of monoclonal gammopathy in patients.
Serum protein electrophoresis is used to identify patients with multiple myeloma and other serum protein disorders. Ppt protein electrophoresis powerpoint presentation. Ppt monoclonal gammopathy of undetermined significance. Mgus typically does not cause any problems, although some affected people may experience numbness, tingling or weakness. Iga antiglomerular basement membrane disease associated. Many subspecialists include serum protein electrophoresis screening in the initial evaluation for numerous clinical conditions. Graftversustumor effects in patients with solid tumors have most often been observed in those with a history of either acute or chronic gvhd, although disease regression has been observed in some patients without any apparent gvhd.
Dec 11, 2014 microabstractto clarify the pathophysiology of multiple myeloma mm it is necessary to investigate the various developmental stages of bcells. Monoclonal gammopathies of undetermined significance mgus. Scribd is the worlds largest social reading and publishing site. The genesis of the topic for this multinational issue of advances in chronic kidney disease, with guest editors colin hutchinson and paul sanders, began that evening.
Clinical features and treatment outcomes of patients with. Oct 04, 2018 monoclonal gammopathy is defined by the presence in serum andor urine of a monoclonal immunoglobulin produced by an abnormal bcell clone. Immunodiffusion is a qualitative or semiquantitative test based on the principles of double diffusion described by oudin and ouchterlony. Chandan n intern, department of medicine, mims, mandya 2. Albumin is the most abundant single protein in serum and forms a single distinct band in the gel. Monoclonal gammopathy of undetermined significance mgus is one of the most common premalignant disorders and affects approximately 3. A monoclonal antibody, by contrast, represents antibody from a single antibody producing b cell and therefore only binds with one unique epitope. Management of monoclonal gammopathy of undetermined.
Protein electrophoresis is an inexpensive tool that is widely available to the practitioner for the investigation of hyperglobulinaemias. Graft versus tumor effect an overview sciencedirect topics. Ppt monoclonal gammopathy of undetermined significance mgus powerpoint presentation free to download id. Click create pdf xps document, then click create pdf xps. Through a series of subsequent meetings, the term monoclonal gammopathy of renal significance mgrs was refined and introduced in 2012 to distinguish these monoclonal gammopathies from mgus. Reviews australian association of clinical biochemists 303. Double gammopathy of undetermined significancea first case. The real incidence of monoclonal gammopathy is unknown. Malignant disorder of plasma cells 10% of monoclonal gammopathies deposit of a fibrillar proteinaceous material detected by congo red staining in various tissues i. Corticosteroids and immunomodulatory drugs may be used. Most common monoclonal gammopathy 5065% of all gammopathies mgus is found in 3% of individuals aged 50 years 1% lifelong risk per year of progression to mm treatment none required close followup to detect appearance of malignancy. Each band on the spe gel represents one or more proteins with similar size and charge characteristics. The cryoglobulinemia, particularly type 1 or monoclonal, is a rare disease with variable severity and diverse clinical manifestations and may lead to death due to multisystem failure and secondary infections.
Hypercalcaemia, which is present in 1520% of myeloma patients at presentation, is a major but treatable cause of renal insufficiency. Feb 11, 2020 monoclonal gammopathy of undetermined significance mgus is the most common of a spectrum of diseases called plasma cell dyscrasias. Mgus resembles multiple myeloma and similar diseases, but the levels of antibodies are. Jan 01, 2020 home immunology immunoelectrophoresis principle, procedure, results and applications, advantages and limitations. Monoclonal gammopathy of undetermined significance. Ppt protein electrophoresis powerpoint presentation free. Management and treatment of glomerular diseases part 2. Monoclonal gammopathy of renal significance mgrs regroups all renal disorders caused by a monoclonal immunoglobulin mig secreted by a nonmalignant bcell clone. Diagnosis of monoclonal gammopathy of renal significance. Getting acquainted with varied aspects of clinical presentation of the monoclonal gammopathies mg and their association with different conditions. We report the findings from a single tertiary medical center retrospective study describing the clinical features of 35 patients with necrobiotic xanthogranuloma and monoclonal gammopathy and their subsequent disease course and response to treatment.
Immunoelectrophoresis principle, procedure, results and applications, advantages and limitations. M bands in gamma region was double gammopathy without any underlying plasma cell or. Get detailed treatment information in this summary for clinicians. Distinguishing polyclonal ie, inflammatory gammopathies from monoclonal gammopathies ie, those due principally to the production of immunoglobulins by a neoplastic clone of bcells is obviously of paramount importance. Mgus is defined as a serum m monoclonal protein myeloma. Monoclonal immunoglobulinemia an overview sciencedirect topics. The early recognition and treatment of this disease are essential for a good prognosis. Antiglomerular basement membrane antigbm disease is characterized by a linear deposition of immunoglobulins along the glomerular basement membrane. Monoclonal gammopathiesclinical and laboratory issues article pdf available in the clinical biochemist. Melphalan most often is used with prednisone to treat multiple myeloma. These individuals, as representatives of the international kidney and monoclonal gammopathy research group, have undertaken several tasks. A reduction of bcells and differentiation shift to more numerous antigenstimulated forms was observed in mm. Monoclonal gammopathy of undetermined significance wikipedia. Jul 06, 2011 myopathies a special and seperate entity with specific features in each disorder making us easy for diagnosis,confirmation by muscle biopsy.
The clinical presentation of al amyloidosis varies. In monoclonal gammopathies, a proteinuria pattern may show a discrete band produced. Plasma cell neoplasms including multiple myeloma treatment include observation, chemotherapy, radiation, stem cell rescue, targeted, and supportive therapies. The remainder had hypogammaglobulinemia or a normalappearing pattern. The three major immunoglobulins igg, iga, igm are usually increased in variable relative concentrations. Serum free light chain flc analysis represents a major advance in laboratory diagnostics. Monoclonal gammopathy of undetermined significance mgus is defined by the. Pdf how i treat monoclonal gammopathy of renal significance. It is a process of a combination of immunodiffusion and electrophoresis. Monoclonal igm gammopathy differential diagnosis, clinical.
Polyclonal gammopathies result from chronic stimulation of the immune system. Improving global outcomes kdigo controversies conference brad h. Electrophoresis separates proteins based on their physical properties, and the. We characterized the spectrum of renal diseases associated with monoclonal gammopathy and renal diseases. The term mgus denotes the presence of a monoclonal immunoglobulin ig, also called an mprotein, in the serum or urine in persons without evidence of multiple myeloma mm, waldenstrom macroglobulinemia wm. Recently, the term monoclonal gammopathy of renal significance mgrs was introduced to distinguish monoclonal gammopathies that result in the development of kidney disease from those that are benign. Monoclonal gammopathy of undetermined significance mgus is a premalignant, clonal plasma cell disorder, characterized by the presence of a monoclonal m protein, pdf file it freezes the formatting and layout. Criteria for the classification of monoclonal gammopathies, multiple. How i manage monoclonal gammopathy of undetermined. Immunoelectrophoresis principle, procedure, results and. Microabstractto clarify the pathophysiology of multiple myeloma mm it is necessary to investigate the various developmental stages of bcells.
Pdf monoclonal gammopathiesclinical and laboratory issues. Polyclonal gammopathies are characterized by broad, diffuse increases in the gamma region of the serum protein electrophoresis pattern. In monoclonal gammopathy of undetermined significance mgus or. Monoclonal gammopathy of undetermined significance genetic. Patients with monoclonal gammopathy can develop a variety of related renal lesions or possibly have kidney disease unrelated to their monoclonal gammopathy. Following the evolution and pathogenesis from mgus to myelomas or lymphomas. Ancaassociated nephritis, and monoclonal gammopathies of renal signi. Serum protein electrophoresis spe separates proteins into multiple bands based on the size and charge of the protein. Definition myopathies are disorders with structural changes or functional impairment of muscle. Monoclonal gammopathies evaluation of asymptomatic mgus cbc urea, creatinine, calcium, phosphorus and uric acid serum protein electrophoresis and immunofixation quantitative immunoglobulins 24 hour urine for total protein and light chains.
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