Table 3.

Renal lesions associated with monoclonal gammopathy

Lesion	Proportion of lesions (%)
	Monoclonal immunoglobulin deposits	Detectable monoclonal immunoglobulin	MM	MGRS	Othera	Refs
Light-chain cast nephropathy	100	100	99	0	~1	2,4,11,13
Immunoglobulin-related amyloid amyloidosis	96	99	16	80	1–4	43,113,128,129
MIDD	100	100	0–20	78–100	1–2	29,31,68,130,131
Light-chain proximal tubulopathy	100	97b	12–33	61–80	3–8	32,56,58,132
Cryoglobulinaemic (type I) glomerulonephritis	100	90–100	6–8	47–52	24–56	133–136
Cryoglobulinaemic (type II) glomerulonephritis	100	49	0	20	7	133–136
PGNMID	100	30–32	4	96	~1	24,72
Crystal-storing histiocytosis	83	90	33	8	50	137
Cryocrystalglobulin or crystalglobulin nephropathy	91	82	61	18	4	138
Immunotactoid glomerulonephritis	69–93	63–71	0–13	25–50	25–50	23,51
C3 glomerulopathy with monoclonal gammopathyc	0	28–83d	0–40d	40–90	6–10	25,74,75,104
Monoclonal fibrillary glomerulonephritise	100	7–17	0–54	55–98	2–10	44,47,139

MGRS, monoclonal gammopathy of renal significance; MIDD, monoclonal immunoglobulin deposition disease; MM, multiple myeloma; PGNMID, proliferative glomerulonephritis with monoclonal immunoglobulin deposits. ^aHaematological conditions including lymphoplasmacytic lymphoma (Waldenström macroglobulinaemia), smouldering Waldenström macroglobulinaemia, B cell lymphomas, chronic lymphocytic lymphoma and monoclonal B cell lymphocytosis. ^bSensitivity increased by immunofluorescence after pronase digestion. ^cMost instances of fibrillary glomerulonephritis and C3 glomerulopathy are not associated with a monoclonal gammopathy. The percentages for MM, MGRS and other haematological conditions relate to the group of patients who do have a monoclonal gammopathy. ^dPatients over the age of 50 years. ^eIn these patients, the glomerular deposits show light-chain restriction or stain for IgG without light chains, both by frozen tissue and paraffin tissue immunofluorescence (as in 15–17% of patients with fibrillary glomerulonephritis).