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Urinary albumin excretion patterns of patients with cast nephropathy and other monoclonal gammopathy-related kidney diseases #MMPMID23024162
Leung N; Gertz M; Kyle RA; Fervenza FC; Irazabal MV; Eirin A; Kumar S; Cha SS; Rajkumar SV; Lacy MQ; Zeldenrust SR; Buadi FK; Hayman SR; Nasr SH; Sethi S; Ramirez-Alvarado M; Witzig TE; Herrmann SM; Dispenzieri A
Clin J Am Soc Nephrol 2012[Dec]; 7 (12): 1964-8 PMID23024162show ga
BACKGROUND AND OBJECTIVES: Multiple myeloma is responsible for a wide variety of renal pathologies. Urinary protein and monoclonal spike cannot be used to diagnose cast nephropathy (CN). Because albuminuria is a hallmark of glomerular disease, this study evaluated the percentage of urinary albumin excretion (%UAE) as a tool to differentiate CN from Ig light chain amyloidosis (AL), light chain deposition disease (LCDD), and acute tubular necrosis (ATN). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients were selected from the Renal Biopsy Database and the Dysproteinemia Database. Participants were excluded if laboratory data were missing within 1 week of the renal biopsy. The %UAE was obtained from urine protein electrophoresis. RESULTS: From 1992 to 2011, 260 patients were biopsied (177 with AL, 28 with LCDD, 43 with CN, and 12 with ATN). The %UAE for CN patients was significantly lower (7%) than for ATN (25%), LCDD (55%), and AL (70%) patients (P<0.001). Significant differences were also found in serum creatinine, serum albumin, free light chain ratio, total urine protein, and urine monoclonal spike; only the %UAE remained independently associated with CN in a logistic regression model (P<0.001). The area under the curve for the receiver operator characteristic curve for %UAE was 0.99. At <25%, the %UAE had a sensitivity of 0.98, specificity of 0.94, positive predictive value of 0.75, and negative predictive value of 0.99. CONCLUSIONS: This study showed that %UAE was significantly less in CN than the other three renal lesions and %UAE may thus be helpful in diagnosis of CN.
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Clin+J+Am+Soc+Nephrol 2012 ; 7 (12): 1964-8
