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AV Fistula Maturation Rule of 6s — ESENeph MCQ

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HardHaemodialysisAV Fistula Maturation Rule of 6sESENeph

Kidney biopsy shows proliferative glomerulonephritis with monotypic IgG3-kappa deposits. Bone marrow reveals a small clone that does not meet myeloma criteria. What is the overarching diagnosis?

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Correct answer: DMonoclonal gammopathy of renal significance

The best answer is “Monoclonal gammopathy of renal significance”. MGRS captures kidney-damaging monoclonal proteins from clones too small to meet ordinary haematological treatment thresholds; clone characterization then guides treatment. “Multiple myeloma by definition” is less appropriate because the clone does not meet malignancy criteria and kidney toxicity defines MGRS “Primary focal segmental glomerulosclerosis” is less appropriate because the monotypic immune deposits identify another mechanism “Polyclonal infection-related glomerulonephritis” is less appropriate because the deposits are monotypic and linked to a clone “Thin basement membrane nephropathy” is less appropriate because this does not cause monoclonal proliferative deposits

Reference: International Kidney and Monoclonal Gammopathy Research Group consensus: https://pmc.ncbi.nlm.nih.gov/articles/PMC7136169/