Medicine Grand Rounds, Sascha Tuchman and Koyal Jain, “Amyloidosis, Cyanide, Myeloma and Ethanol: Conceptualizing Renal Diseases Caused by Monoclonal Gammopathies”

Monoclonal gammopathies are a group of plasma cell or B-cell disorders including true cancers such as multiple myeloma or “sort-of cancers” such as light chain amyloidosis. These disorders in many cases cause no injury to a person (i.e., monoclonal gammopathy of undetermined significance [MGUS]) but when they do cause injury, the pattern of injury can be quite varied and often includes the kidneys. Monoclonal gammopathy of renal significance (MGRS) is a recently described category of nephrotroxic monoclonal gammopathies that arise in the absence of an overt hematologic malignancy. Monoclonal gammopathies overall have been increasingly recognized as a cause of renal failure. Over 660,000 Americans have kidney failure, and early recognition of the etiology of kidney disease can prevent progression to end-stage kidney disease through aggressive interventions, such as chemotherapy in proven cases of multiple myeloma or MGRS. The management of these patients requires close collaboration between nephrologists and oncologists. In this presentation, we will be focusing on the wide spectrum of diseases associated with nephrotoxic plasma cell disorders, with a focus on how to conceptualize them clinically.

Sascha Tuchman is a UNC Comprehensive Cancer Center member and Associate Professor of Medicine. Dr. Tuchman’s research has a special focus on amyloidosis and multiple myeloma.

Koyal Jain is an Assistant Professor of Medicine in the Nephrology division. She specializes in acute kidney injury and chronic kidney disease, dialysis management, high blood pressure management, abnormalities of electrolytes like sodium, potassium, calcium, and glomerular diseases.