An interdisciplinary approach in the practice of general physician: a focus on monoclonal gammopathy of renal significance (shot version of the Consensus of hematologists and nephrologists of Russia on the establishment of nosology, diagnostic approach and rationale for clone specific treatment)


DOI: https://dx.doi.org/10.18565/therapy.2020.2.22-33

Smirnov A.V., Dobronravov V.A., Khrabrova M.S., Panina I.Yu., Mosina N.V.

1 Scientific Research Institute of Nephrology of I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russia; 2 Department of propaedeutics of internal diseases of I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russia
Monoclonal gammopathy of renal significance (MGRS) is a new nosology in modern nephrology and oncohematology. MGRS is defined as kidney injury due to nephrotoxic monoclonal immunoglobulin produced by the B-cell line clone which does not reach the hematological criteria for specific treatment initiation. Monoclonal protein’s pathological effects on kidney parenchyma result in irreversible decline of kidney function till the end stage renal disease that in line with the position of International Consensus of hematologists and nephrologists determinates critical necessity for clone specific treatment in patients with MGRS despite the absence of hematological indications for treatment initiation.
The issue of MGRS is challenging and important for specialists working at any level of healthcare in Russia. This problem partly lies in the insufficient awareness of specialists, first of all of primary care general physicians, with this nosology. In this article, in order to familiarize a wide audience of general physicians with the new nosology – MGRS – we present an abriged version of the conciliatory document published on behalf of leading hematologists and nephrologists of Russian Federation: «Monoclonal gammopathy of renal significance: Consensus of hematologists and nephrologists of Russia on the establishment of nosology, diagnostic approach and rationale for clone specific treatment».
Consensus document comprises the opinion of experts on the problem of MGRS including the incoherence in nosology classification, diagnostics approach and rationale for clone specific treatment. Consensus document is based on conclusions and agreements reached during the conference of leading nephrologists and hematologists of Russia which was held in the framework of symposia «Plasma cell dyscrasias and lymphoproliferative diseases: modern approaches to therapy», 15–16 of March 2019, I.P. Pavlov First St. Petersburg State medical University. The present Consensus is intended to define the principal practical steps to resolve the problem of MGRS in Russia that are summarized as final clauses.
Keywords: light chains, plasma cell dyscrasias, paraprotein, clone specific treatment, monoclonal gammopathy of undetermined significance, onconephrology, monoclonal gammopathy of renal significance, kidney injury, kidney biopsy
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About the Autors

Alexey V. Smirnov, MD, professor, Director of the Scientific Research Institute of Nephrology of I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 17/54 Leo Tolstoy Str. Tel.: +7 (812) 338-69-01. E-mail: smirnov@nephrolog.ru. ORCID: 0000-0001-7863-9080
Vladimir A. Dobronravov, MD, professor, Deputy Director of studies of the Scientific Research Institute of Neprolology of I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 17/54 Leo Tolstoy Str. Tel.: +7 (812) 338-69-16. E-mail: dobronravov@nephrolog.ru.
ORCID: 0000-0002-7179-5520
Maria S. Khrabrova, PhD, associate professor of the Department of propaedeutics of internal medicine with the Clinic of I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 17/54 Leo Tolstoy Str. Tel.: +7 (812) 338-69-01. E-mail: hrabrovamc@gmail.com.
ORCID: 0000-0002-8141-4488
Irina Yu. Panina, MD, professor of the Department propaedeutics of internal medicine with the Clinic of I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 17/54 Leo Tolstoy Str. Tel.: +7 (812) 338-69-01. E-mail: i.u.panina@mail.ru
Nina V. Mosina, PhD, head of the Department of clinical research of the Scientific research institute of neprolology of I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russia.
Address: 197022, St. Petersburg, 17/54 Leo Tolstoy Str. Tel.: +7 (812) 338-69-01. E-mail: ninamosina@mail.ru


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