HAEM5:Monoclonal immunoglobulin deposition disease: Difference between revisions

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{{DISPLAYTITLE:Monoclonal immunoglobulin deposition disease}}
{{DISPLAYTITLE:Monoclonal immunoglobulin deposition disease}}
[[HAEM5:Table_of_Contents|Haematolymphoid Tumours (WHO Classification, 5th ed.)]]
[[HAEM5:Table_of_Contents|Haematolymphoid Tumours (WHO Classification, 5th ed.)]]


{{Under Construction}}
{{Under Construction}}


<blockquote class='blockedit'>{{Box-round|title=Content Update To WHO 5th Edition Classification Is In Process; Content Below is Based on WHO 4th Edition Classification|This page was converted to the new template on 2023-12-07. The original page can be found at [[HAEM4:Light Chain and Heavy Chain Deposition Disease]].
<blockquote class="blockedit">{{Box-round|title=Content Update To WHO 5th Edition Classification Is In Process; Content Below is Based on WHO 4th Edition Classification|This page was converted to the new template on 2023-12-07. The original page can be found at [[HAEM4:Light Chain and Heavy Chain Deposition Disease]].
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==Definition / Description of Disease==
Light Chain and Heavy Chain Deposition Disease is defined as follows<ref>McKenna RW, et al., (2017). Plasma cell neoplasms: Light chain and heavy chain deposition diseases, in World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues, Revised 4th edition. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Arber DA, Hasserjian RP, Le Beau MM, Orazi A, and Siebert R, Editors. IARC Press: Lyon, France, p255-256.</ref><ref>{{Cite journal|last=Sethi|first=Sanjeev|last2=Rajkumar|first2=S. Vincent|last3=D'Agati|first3=Vivette D.|date=2018-07|title=The Complexity and Heterogeneity of Monoclonal Immunoglobulin-Associated Renal Diseases|url=https://pubmed.ncbi.nlm.nih.gov/29703839|journal=Journal of the American Society of Nephrology: JASN|volume=29|issue=7|pages=1810–1823|doi=10.1681/ASN.2017121319|issn=1533-3450|pmc=6050917|pmid=29703839}}</ref><ref>{{Cite journal|last=Leung|first=Nelson|last2=Bridoux|first2=Frank|last3=Batuman|first3=Vecihi|last4=Chaidos|first4=Aristeidis|last5=Cockwell|first5=Paul|last6=D'Agati|first6=Vivette D.|last7=Dispenzieri|first7=Angela|last8=Fervenza|first8=Fernando C.|last9=Fermand|first9=Jean-Paul|date=2019-01|title=The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group|url=https://pubmed.ncbi.nlm.nih.gov/30510265|journal=Nature Reviews. Nephrology|volume=15|issue=1|pages=45–59|doi=10.1038/s41581-018-0077-4|issn=1759-507X|pmc=7136169|pmid=30510265}}</ref><ref>{{Cite journal|last=Leung|first=Nelson|last2=Bridoux|first2=Frank|last3=Nasr|first3=Samih H.|date=2021-05-20|title=Monoclonal Gammopathy of Renal Significance|url=https://pubmed.ncbi.nlm.nih.gov/34010532|journal=The New England Journal of Medicine|volume=384|issue=20|pages=1931–1941|doi=10.1056/NEJMra1810907|issn=1533-4406|pmid=34010532}}</ref>:
*Systemic disorder with non-amyloid deposits of monoclonal immunoglobulin (Ig) in various organs
*Underlying diseases are [[HAEM4:Plasma Cell Neoplasms]] (PCN, >95%) or lymphoplasmacytic neoplasms (2-3%)
*20-35% have non-smoldering [[HAEM5:Plasma cell myeloma / multiple myeloma]] (PCM), and rest (65-75%) have smoldering plasma cell myeloma or Monoclonal Gammopathy of Uncertain Significance (MGUS)/monoclonal gammopathy of renal significance (MGRS)
==Synonyms / Terminology==
*Randall type monoclonal immunoglobulin deposition disease
*Light chain deposition disease (LCDD)
*heavy chain deposition disease (HCDD)
*light and heavy chain deposition disease (LHCDD)
==Epidemiology / Prevalence==
The following epidemiologic features have been observed<ref name=":0">{{Cite journal|last=Pozzi|first=Claudio|last2=D'Amico|first2=Marco|last3=Fogazzi|first3=Giovanni B.|last4=Curioni|first4=Simona|last5=Ferrario|first5=Franco|last6=Pasquali|first6=Sonia|last7=Quattrocchio|first7=Giacomo|last8=Rollino|first8=Cristiana|last9=Segagni|first9=Siro|date=2003-12|title=Light chain deposition disease with renal involvement: clinical characteristics and prognostic factors|url=https://pubmed.ncbi.nlm.nih.gov/14655186|journal=American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation|volume=42|issue=6|pages=1154–1163|doi=10.1053/j.ajkd.2003.08.040|issn=1523-6838|pmid=14655186}}</ref><ref name=":2">{{Cite journal|last=Nasr|first=Samih H.|last2=Valeri|first2=Anthony M.|last3=Cornell|first3=Lynn D.|last4=Fidler|first4=Mary E.|last5=Sethi|first5=Sanjeev|last6=D'Agati|first6=Vivette D.|last7=Leung|first7=Nelson|date=2012-02|title=Renal monoclonal immunoglobulin deposition disease: a report of 64 patients from a single institution|url=https://pubmed.ncbi.nlm.nih.gov/22156754|journal=Clinical journal of the American Society of Nephrology: CJASN|volume=7|issue=2|pages=231–239|doi=10.2215/CJN.08640811|issn=1555-905X|pmid=22156754}}</ref><ref name=":1">{{Cite journal|last=Joly|first=Florent|last2=Cohen|first2=Camille|last3=Javaugue|first3=Vincent|last4=Bender|first4=Sébastien|last5=Belmouaz|first5=Mohamed|last6=Arnulf|first6=Bertrand|last7=Knebelmann|first7=Bertrand|last8=Nouvier|first8=Mathilde|last9=Audard|first9=Vincent|date=2019-02-07|title=Randall-type monoclonal immunoglobulin deposition disease: novel insights from a nationwide cohort study|url=https://pubmed.ncbi.nlm.nih.gov/30578255|journal=Blood|volume=133|issue=6|pages=576–587|doi=10.1182/blood-2018-09-872028|issn=1528-0020|pmid=30578255}}</ref><ref name=":4" />:
*Vary rare
*Median age: 56-58 years (range: 20-91)
*60% are men
*No ethnic difference
*Deposited Ig can be light chain (LCDD, ~80%), heavy chain (HCDD, ~10%), or both (LHCDD, ~10%)
==Clinical Features==
Put your text here and fill in the table <span style="color:#0070C0">(''Instruction: Can include references in the table. Do not delete table.'') </span>
{| class="wikitable"
|'''Signs and Symptoms'''
|<span class="blue-text">EXAMPLE:</span> Asymptomatic (incidental finding on complete blood counts)
<span class="blue-text">EXAMPLE:</span> B-symptoms (weight loss, fever, night sweats)
<span class="blue-text">EXAMPLE:</span> Fatigue
<span class="blue-text">EXAMPLE:</span> Lymphadenopathy (uncommon)
|-
|'''Laboratory Findings'''
|<span class="blue-text">EXAMPLE:</span> Cytopenias
<span class="blue-text">EXAMPLE:</span> Lymphocytosis (low level)
|}
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The following clinical and laboratory findings may be seen<ref name=":0" /><ref name=":2" /><ref name=":1" /><ref name=":4" /><ref name=":3">{{Cite journal|last=Mohan|first=Meera|last2=Buros|first2=Amy|last3=Mathur|first3=Pankaj|last4=Gokden|first4=Neriman|last5=Singh|first5=Manisha|last6=Susanibar|first6=Sandra|last7=Jo Kamimoto|first7=Jorge|last8=Hoque|first8=Shadiqul|last9=Radhakrishnan|first9=Muthukumar|date=2017-08|title=Clinical characteristics and prognostic factors in multiple myeloma patients with light chain deposition disease|url=https://pubmed.ncbi.nlm.nih.gov/28383130|journal=American Journal of Hematology|volume=92|issue=8|pages=739–745|doi=10.1002/ajh.24756|issn=1096-8652|pmid=28383130}}</ref><ref name=":5">{{Cite journal|last=Sayed|first=Rabya H.|last2=Wechalekar|first2=Ashutosh D.|last3=Gilbertson|first3=Janet A.|last4=Bass|first4=Paul|last5=Mahmood|first5=Shameem|last6=Sachchithanantham|first6=Sajitha|last7=Fontana|first7=Marianna|last8=Patel|first8=Ketna|last9=Whelan|first9=Carol J.|date=2015-12-24|title=Natural history and outcome of light chain deposition disease|url=https://pubmed.ncbi.nlm.nih.gov/26392598|journal=Blood|volume=126|issue=26|pages=2805–2810|doi=10.1182/blood-2015-07-658872|issn=1528-0020|pmc=4732758|pmid=26392598}}</ref>:
'''Signs & Symptoms'''
*Organ dysfunction resulting from systemic Ig deposition
*Renal dysfunction (renal insufficiency, proteinuria, hematuria, and hypertension) in almost all cases
*Renal failure eventually without treatment
*Extrarenal symptoms (10-35%) from IG deposition in heart, liver, peripheral nerves, lung, skin, blood vessels, and occasionally joints
*Diastolic heart failure and atrial arrhythmias if heart involved
*Hepatomegaly, portal hypertension and liver failure if liver involved
*Cough, oxygen desaturation and dyspnea if lung involved
*Peripheral and autonomic neuropathy if nerve involved
'''Laboratory findings'''
*Abnormal serum free light chain ratio in almost all cases
*M-protein detected on SPEP in majority (70-85%) cases
*IgG followed by light chain, IgA and IgM, as the most common monoclonal Ig detected in serum
*The tissue immunoglobulin deposits can differ from the monoclonal Ig in serum
*Hypocomplementemia in HCDD, due to complement fixation by IgG3 and IgG1 subclasses
*Septal thickening on echocardiogram if heart involved
*Elevated liver function test results if liver involved
<blockquote class="blockedit">
<center><span style="color:Maroon">'''End of V4 Section'''</span>
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</blockquote>
==Sites of Involvement==
The following anatomic sites of involvement have been reported<ref name=":2" /><ref name=":1" /><ref name=":4" /><ref name=":3" />:
*Kidney is nearly always involved
*Extrarenal organs (heart, liver, peripheral nerves, lung, skin, and blood vessels) involve in 10-35% cases
*Extrarenal involvement is more common in LCDD with PCM
*Basement membranes and elastic and collagen fibers are the prominent deposition sites
==Morphologic Features==
*Most cases are associated with PCM or MGUS<ref name=":0" />, and rarely with [[HAEM5:Lymphoplasmacytic lymphoma]], marginal zone lymphoma, or [[HAEM5:Chronic lymphocytic leukaemia/small lymphocytic lymphoma]]
*The smooth, ribbon-like linear Ig deposits consist of Congo red-negative amorphous eosinophilic material that is non-amyloid and non-fibrillary
*Deposition of Ig is mostly found on renal biopsies but can be observed in bone marrow and other tissues
*The renal biopsy typically (in 2/3 of cases) shows nodular sclerosing glomerulonephritis
*Ig predominantly deposits along tubular basement membranes (TBM) and glomerular basement membranes (GBM) under kidney immunofluorescence stain<ref name=":2" />
==Immunophenotype==
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{| class="wikitable sortable"
|-
!Finding!!Marker
|-
|Positive (universal)||<span class="blue-text">EXAMPLE:</span> CD1
|-
|Positive (subset)||<span class="blue-text">EXAMPLE:</span> CD2
|-
|Negative (universal)||<span class="blue-text">EXAMPLE:</span> CD3
|-
|Negative (subset)||<span class="blue-text">EXAMPLE:</span> CD4
|}
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Findings are similar to those of the underlying condition (e.g., [[HAEM4:Plasma Cell Neoplasms|Plasma Cell Neoplasm]], [[HAEM5:Lymphoplasmacytic lymphoma]]).  Additional findings may include the following<ref name=":2" /><ref name=":4" />:
*The plasma cells in bone marrow may exhibit an aberrant kappa/lambda ratio
*Kappa light chains, especially VκIV variable region, are overrepresented (68-80%) in LCDD
*Gamma chains are most common in HCDD
*Deletion of the CH1 constant domain leads to premature secretion and tissue deposition of heavy chain in HCDD
*Somatic mutations of the variable regions of light chain or heavy chain increase the hydrophobicity and hence the propensity for tissue deposition of Ig
<blockquote class="blockedit">
<center><span style="color:Maroon">'''End of V4 Section'''</span>
----
</blockquote>
==WHO Essential and Desirable Genetic Diagnostic Criteria==
==WHO Essential and Desirable Genetic Diagnostic Criteria==
<span style="color:#0070C0">(''Instructions: The table will have the diagnostic criteria from the WHO book <u>autocompleted</u>; remove any <u>non</u>-genetics related criteria. If applicable, add text about other classification'' ''systems that define this entity and specify how the genetics-related criteria differ.'')</span>
<span style="color:#0070C0">(''Instructions: The table will have the diagnostic criteria from the WHO book <u>autocompleted</u>; remove any <u>non</u>-genetics related criteria. If applicable, add text about other classification'' ''systems that define this entity and specify how the genetics-related criteria differ.'')</span>
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*There is limited information on the genomic abnormalities of the plasma cells in light chain and heavy chain deposition disease
*There is limited information on the genomic abnormalities of the plasma cells in light chain and heavy chain deposition disease
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<blockquote class='blockedit'>{{Box-round|title=v4:Clinical Significance (Diagnosis, Prognosis and Therapeutic Implications).|Please incorporate this section into the relevant tables found in:
<blockquote class="blockedit">{{Box-round|title=v4:Clinical Significance (Diagnosis, Prognosis and Therapeutic Implications).|Please incorporate this section into the relevant tables found in:
* Chromosomal Rearrangements (Gene Fusions)
* Chromosomal Rearrangements (Gene Fusions)
* Individual Region Genomic Gain/Loss/LOH
* Individual Region Genomic Gain/Loss/LOH
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*Findings are similar to those of the underlying condition (e.g., [[HAEM4:Plasma Cell Neoplasms|Plasma Cell Neoplasm]], [[HAEM5:Lymphoplasmacytic lymphoma]])
*Findings are similar to those of the underlying condition (e.g., [[HAEM4:Plasma Cell Neoplasms|Plasma Cell Neoplasm]], [[HAEM5:Lymphoplasmacytic lymphoma]])
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*Patients with PCM presumably have similar genomic abnormalities to myelomas without Ig deposition, perhaps with a different prevalence
*Patients with PCM presumably have similar genomic abnormalities to myelomas without Ig deposition, perhaps with a different prevalence
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|}Note: A more extensive list of mutations can be found in [https://www.cbioportal.org/ <u>cBioportal</u>], [https://cancer.sanger.ac.uk/cosmic <u>COSMIC</u>], and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content.
|}Note: A more extensive list of mutations can be found in [https://www.cbioportal.org/ <u>cBioportal</u>], [https://cancer.sanger.ac.uk/cosmic <u>COSMIC</u>], and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content.


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*Findings are similar to those of the underlying condition (e.g., [[HAEM4:Plasma Cell Neoplasms|Plasma Cell Neoplasm]], [[HAEM5:Lymphoplasmacytic lymphoma]])
*Findings are similar to those of the underlying condition (e.g., [[HAEM4:Plasma Cell Neoplasms|Plasma Cell Neoplasm]], [[HAEM5:Lymphoplasmacytic lymphoma]])
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*Findings are similar to those of the underlying condition (e.g., [[HAEM4:Plasma Cell Neoplasms|Plasma Cell Neoplasm]], [[HAEM5:Lymphoplasmacytic lymphoma]])
*Findings are similar to those of the underlying condition (e.g., [[HAEM4:Plasma Cell Neoplasms|Plasma Cell Neoplasm]], [[HAEM5:Lymphoplasmacytic lymphoma]])
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==Genetic Diagnostic Testing Methods==
==Genetic Diagnostic Testing Methods==
Testing methods include those needed to diagnose the underlying condition, as well as those specifically needed to detect the offending Ig in liquid samples and tissues.  The following methods of testing have been reported<ref name=":0" /><ref name=":2" /><ref name=":1" /><ref name=":4" /><ref name=":3" />:
Testing methods include those needed to diagnose the underlying condition, as well as those specifically needed to detect the offending Ig in liquid samples and tissues.  The following methods of testing have been reported<ref name=":0">{{Cite journal|last=Pozzi|first=Claudio|last2=D'Amico|first2=Marco|last3=Fogazzi|first3=Giovanni B.|last4=Curioni|first4=Simona|last5=Ferrario|first5=Franco|last6=Pasquali|first6=Sonia|last7=Quattrocchio|first7=Giacomo|last8=Rollino|first8=Cristiana|last9=Segagni|first9=Siro|date=2003-12|title=Light chain deposition disease with renal involvement: clinical characteristics and prognostic factors|url=https://pubmed.ncbi.nlm.nih.gov/14655186|journal=American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation|volume=42|issue=6|pages=1154–1163|doi=10.1053/j.ajkd.2003.08.040|issn=1523-6838|pmid=14655186}}</ref><ref name=":2">{{Cite journal|last=Nasr|first=Samih H.|last2=Valeri|first2=Anthony M.|last3=Cornell|first3=Lynn D.|last4=Fidler|first4=Mary E.|last5=Sethi|first5=Sanjeev|last6=D'Agati|first6=Vivette D.|last7=Leung|first7=Nelson|date=2012-02|title=Renal monoclonal immunoglobulin deposition disease: a report of 64 patients from a single institution|url=https://pubmed.ncbi.nlm.nih.gov/22156754|journal=Clinical journal of the American Society of Nephrology: CJASN|volume=7|issue=2|pages=231–239|doi=10.2215/CJN.08640811|issn=1555-905X|pmid=22156754}}</ref><ref name=":1">{{Cite journal|last=Joly|first=Florent|last2=Cohen|first2=Camille|last3=Javaugue|first3=Vincent|last4=Bender|first4=Sébastien|last5=Belmouaz|first5=Mohamed|last6=Arnulf|first6=Bertrand|last7=Knebelmann|first7=Bertrand|last8=Nouvier|first8=Mathilde|last9=Audard|first9=Vincent|date=2019-02-07|title=Randall-type monoclonal immunoglobulin deposition disease: novel insights from a nationwide cohort study|url=https://pubmed.ncbi.nlm.nih.gov/30578255|journal=Blood|volume=133|issue=6|pages=576–587|doi=10.1182/blood-2018-09-872028|issn=1528-0020|pmid=30578255}}</ref><ref name=":4" /><ref name=":3">{{Cite journal|last=Mohan|first=Meera|last2=Buros|first2=Amy|last3=Mathur|first3=Pankaj|last4=Gokden|first4=Neriman|last5=Singh|first5=Manisha|last6=Susanibar|first6=Sandra|last7=Jo Kamimoto|first7=Jorge|last8=Hoque|first8=Shadiqul|last9=Radhakrishnan|first9=Muthukumar|date=2017-08|title=Clinical characteristics and prognostic factors in multiple myeloma patients with light chain deposition disease|url=https://pubmed.ncbi.nlm.nih.gov/28383130|journal=American Journal of Hematology|volume=92|issue=8|pages=739–745|doi=10.1002/ajh.24756|issn=1096-8652|pmid=28383130}}</ref>:


*Diagnosis relies on detection of monoclonal Ig deposition in tissues biopsy; fine needle aspiration is not enough for diagnosis
*Diagnosis relies on detection of monoclonal Ig deposition in tissues biopsy; fine needle aspiration is not enough for diagnosis
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==Additional Information==
==Additional Information==


*Survival improves with early diagnosis and proteasome inhibitor (PI)-based treatment, autologous stem cell transplantation, and kidney transplantation<ref name=":5" /><ref name=":6">{{Cite journal|last=Cohen|first=Camille|last2=Royer|first2=Bruno|last3=Javaugue|first3=Vincent|last4=Szalat|first4=Raphael|last5=El Karoui|first5=Khalil|last6=Caulier|first6=Alexis|last7=Knebelmann|first7=Bertrand|last8=Jaccard|first8=Arnaud|last9=Chevret|first9=Sylvie|date=2015-11|title=Bortezomib produces high hematological response rates with prolonged renal survival in monoclonal immunoglobulin deposition disease|url=https://pubmed.ncbi.nlm.nih.gov/26176826|journal=Kidney International|volume=88|issue=5|pages=1135–1143|doi=10.1038/ki.2015.201|issn=1523-1755|pmid=26176826}}</ref>
*Survival improves with early diagnosis and proteasome inhibitor (PI)-based treatment, autologous stem cell transplantation, and kidney transplantation<ref name=":5">{{Cite journal|last=Sayed|first=Rabya H.|last2=Wechalekar|first2=Ashutosh D.|last3=Gilbertson|first3=Janet A.|last4=Bass|first4=Paul|last5=Mahmood|first5=Shameem|last6=Sachchithanantham|first6=Sajitha|last7=Fontana|first7=Marianna|last8=Patel|first8=Ketna|last9=Whelan|first9=Carol J.|date=2015-12-24|title=Natural history and outcome of light chain deposition disease|url=https://pubmed.ncbi.nlm.nih.gov/26392598|journal=Blood|volume=126|issue=26|pages=2805–2810|doi=10.1182/blood-2015-07-658872|issn=1528-0020|pmc=4732758|pmid=26392598}}</ref><ref name=":6">{{Cite journal|last=Cohen|first=Camille|last2=Royer|first2=Bruno|last3=Javaugue|first3=Vincent|last4=Szalat|first4=Raphael|last5=El Karoui|first5=Khalil|last6=Caulier|first6=Alexis|last7=Knebelmann|first7=Bertrand|last8=Jaccard|first8=Arnaud|last9=Chevret|first9=Sylvie|date=2015-11|title=Bortezomib produces high hematological response rates with prolonged renal survival in monoclonal immunoglobulin deposition disease|url=https://pubmed.ncbi.nlm.nih.gov/26176826|journal=Kidney International|volume=88|issue=5|pages=1135–1143|doi=10.1038/ki.2015.201|issn=1523-1755|pmid=26176826}}</ref>
*Poor prognosis markers include old age, the presence of PCM, extrarenal (especially cardiac) involvement, poor response to initial treatment<ref name=":1" /><ref>{{Cite journal|last=Angel-Korman|first=Avital|last2=Stern|first2=Lauren|last3=Angel|first3=Yoel|last4=Sarosiek|first4=Shayna|last5=Menn-Josephy|first5=Hanni|last6=Francis|first6=Jean|last7=Ghai|first7=Sandeep|last8=Sloan|first8=J. Mark|last9=Sanchorawala|first9=Vaishali|date=2020-04|title=The Role of Kidney Transplantation in Monoclonal Ig Deposition Disease|url=https://pubmed.ncbi.nlm.nih.gov/32274452|journal=Kidney International Reports|volume=5|issue=4|pages=485–493|doi=10.1016/j.ekir.2020.01.011|issn=2468-0249|pmc=7136323|pmid=32274452}}</ref>
*Poor prognosis markers include old age, the presence of PCM, extrarenal (especially cardiac) involvement, poor response to initial treatment<ref name=":1" /><ref>{{Cite journal|last=Angel-Korman|first=Avital|last2=Stern|first2=Lauren|last3=Angel|first3=Yoel|last4=Sarosiek|first4=Shayna|last5=Menn-Josephy|first5=Hanni|last6=Francis|first6=Jean|last7=Ghai|first7=Sandeep|last8=Sloan|first8=J. Mark|last9=Sanchorawala|first9=Vaishali|date=2020-04|title=The Role of Kidney Transplantation in Monoclonal Ig Deposition Disease|url=https://pubmed.ncbi.nlm.nih.gov/32274452|journal=Kidney International Reports|volume=5|issue=4|pages=485–493|doi=10.1016/j.ekir.2020.01.011|issn=2468-0249|pmc=7136323|pmid=32274452}}</ref>
*Elimination or reduction of the underlying B-cell proliferative neoplasms to control the aberrant Ig deposition is crucial for preventing disease progression<ref name=":6" /><ref name=":5" />
*Elimination or reduction of the underlying B-cell proliferative neoplasms to control the aberrant Ig deposition is crucial for preventing disease progression<ref name=":6" /><ref name=":5" />
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(use the "Cite" icon at the top of the page) <span style="color:#0070C0">(''Instructions: Add each reference into the text above by clicking where you want to insert the reference, selecting the “Cite” icon at the top of the wiki page, and using the “Automatic” tab option to search by PMID to select the reference to insert. If a PMID is not available, such as for a book, please use the “Cite” icon, select “Manual” and then “Basic Form”, and include the entire reference. To insert the same reference again later in the page, select the “Cite” icon and “Re-use” to find the reference; DO NOT insert the same reference twice using the “Automatic” tab as it will be treated as two separate references. The reference list in this section will be automatically generated and sorted''</span><span style="color:#0070C0">''.''</span><span style="color:#0070C0">)</span> <references />
(use the "Cite" icon at the top of the page) <span style="color:#0070C0">(''Instructions: Add each reference into the text above by clicking where you want to insert the reference, selecting the “Cite” icon at the top of the wiki page, and using the “Automatic” tab option to search by PMID to select the reference to insert. If a PMID is not available, such as for a book, please use the “Cite” icon, select “Manual” and then “Basic Form”, and include the entire reference. To insert the same reference again later in the page, select the “Cite” icon and “Re-use” to find the reference; DO NOT insert the same reference twice using the “Automatic” tab as it will be treated as two separate references. The reference list in this section will be automatically generated and sorted''</span><span style="color:#0070C0">''.''</span><span style="color:#0070C0">)</span> <references />


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==Notes==
==Notes==
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<nowiki>*</nowiki>''Citation of this Page'': “Monoclonal immunoglobulin deposition disease”. Compendium of Cancer Genome Aberrations (CCGA), Cancer Genomics Consortium (CGC), updated {{REVISIONMONTH}}/{{REVISIONDAY}}/{{REVISIONYEAR}}, <nowiki>https://ccga.io/index.php/HAEM5:Monoclonal_immunoglobulin_deposition_disease</nowiki>.
<nowiki>*</nowiki>''Citation of this Page'': “Monoclonal immunoglobulin deposition disease”. Compendium of Cancer Genome Aberrations (CCGA), Cancer Genomics Consortium (CGC), updated {{REVISIONMONTH}}/{{REVISIONDAY}}/{{REVISIONYEAR}}, <nowiki>https://ccga.io/index.php/HAEM5:Monoclonal_immunoglobulin_deposition_disease</nowiki>.
[[Category:HAEM5]][[Category:DISEASE]][[Category:Diseases M]]
[[Category:HAEM5]]
[[Category:DISEASE]]
[[Category:Diseases M]]