avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2021-11-5-325-334avk-1295Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESМоноклональная гаммапатия ренального значения: морфологические варианты пораженияMonoclonal Gammapathy of Renal Significance: Morphological Variants of Lesionhttps://orcid.org/0000-0003-2139-5446ФоминаН. В.FominaN. V.

Кемерово

Kemerovo

https://orcid.org/0000-0002-2000-3562УткинаЕ. В.UtkinaE. V.

Екатерина Владимировна Уткина

Кемерово

Ekaterina V. Utkina

Kemerovo

goll1997.2011@mail.ruГАУЗ Кемеровская областная клиническая больница им. С.В. Беляева; Кемеровский государственный медицинский университет Минздрава РоссииРоссияKemerovo Regional Clinical Hospital named after S.V. Belyaev; — Kemerovo State Medical University of the Ministry of Health of RussiaRussian FederationКемеровский государственный медицинский университет Минздрава РоссииРоссияKemerovo State Medical University of the Ministry of Health of RussiaRussian Federation202127092021115325334Copyright © Фомина Н.В., Уткина Е.В., 20212021Фомина Н.В., Уткина Е.В.Fomina N.V., Utkina E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/1295

В статье рассматривается понятие моноклональная гаммапатия ренальног о значения, которое объединяет различные почечные заболевания, вызванные отложением моноклонального иммуноглобулина и/или их компонентов в клубочках и тубулоинтерстиции. Данная нозологическая группа была выделена из группы моноклональная гаммапатия неопределенного значения (в 2012 году). Представлены данные по изучению морфологического поражения почек, ассоциированного с моноклональной гаммапатией ренального значения. Спектр почечных заболеваний при моноклональной гаммапатии ренального значения разнообразен, и его классификация основана на локализации почечных поражений в клубочках, канальцах, интерстиции сосудов и стромы, а также особенностью отложения иммуноглобулинов (организованные и неорганизованные). Биопсия почки показана в большинстве случаев для определения локализации поражения, оценки его тяжести и прогноза выживаемости для пациента. Диагностика требует интеграции морфологических изменений с помощью световой микроскопии, иммунофлуоресценции, электронной микроскопии, а в некоторых случаях применяют окрашивание моноклонального белка на изотипы Ig (окраска гематоксилином/эозином, реакция Шиффа (PAS-реакция), серебрение по Джонсу, окраска по конго-рот, трихромальная окраска по Массону). Ранняя диагностика и своевременное назначение гематологом и/или гематоонкологом клон-ориентированной терапии позволяет остановить прогрессирование злокачественного процесса и снижения функции почек. В свою очередь, нефролог, взаимодействуя с гематологом и/или гематоонкологом, ведет наблюдение за пациентом.

The article discusses the concept of monoclonal renal gammopathy, which combines various renal diseases caused by the deposition of monoclonal immunoglobulin and / or their components in the glomeruli and tubulointerstitium. This nosological group was identified within the group of monoclonal gammopathies of undetermined significance (in 2012). The data on the study of morphological kidney damage associated with monoclonal renal gammopathy are presented. The spectrum of renal diseases in monoclonal renal gammopathy is diverse, and its classification is based on the localization of renal lesions in the glomeruli, tubules, vascular interstitium and stroma, as well as the peculiarity of the deposition of immunoglobulins (organized and unorganized). Kidney biopsy is required in most cases to locate the lesion, assess its severity, and predict patient survival. Diagnostics requires the integration of morphological changes using light microscopy, immunofluorescence, electron microscopy, and in some cases, staining of monoclonal protein for Ig isotypes is used (staining with hematoxylin / eosin, Schiff stain (PAS reaction), Jones stain, Congo Red stain, Masson’s trichromal stain). Early diagnosis and timely prescription of clone-oriented therapy by a hematologist and / or a hematooncologist can stop the progression of the malignant process and kidney malfunction. A nephrologist should monitor the patient, interacting with the hematologist.

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The authors declare that there are no conflicts of interest present.