Monoclonal Gammopathy of Renal Significance: A Molecular Middle Earth between Oncology, Nephrology, and Pathology
Vincenzo L'Imperio1, Giorgio Cazzaniga1, Barbara Vergani1
1Department of Medicine and Surgery, Pathology, ASST Monza, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy.
Background:
The renal biopsy represents a cornerstone in the definition of monoclonal gammopathy of renal significance (MGRS), helping in identifying patients with sub-detectable neoplastic clones (MGUS) that would deserve aggressive chemotherapies. However, the rising complexity of this onco-nephrology field is significantly challenging the daily work of nephrologists and nephropathologists, leading to the formation of ultra-specialized international centers with dedicated personnel/instrumentation and stressing the need for a better understanding of the underlying molecular landscape of these entities.
Summary:
In this setting, the application of proteomic techniques, some with in situ capabilities (e.g., MALDI-MS imaging), for the investigation of the most challenging MGRS is progressively shedding light on the pathobiology of these diseases, providing new insights in the diagnosis and prognosis of these cases. This transformation is further enhanced by the application of next-generation digital pathology platforms, leading to a significant improvement of the cultural background for physicians thanks to second opinions, database and atlas creation, enhancement of diagnostic reports, with obvious repercussions for patients both in terms of turnaround time and appropriateness.
Key Messages:
The present review is aimed at bridging the gap between clinical questions (i.e., a better characterization of MGRS) and the molecular landscape of onco-nephrology entities.
Insights
Renal biopsy is key for diagnosing monoclonal gammopathy of renal significance (MGRS), guiding treatment for patients with hidden cancer clones. Advanced proteomic and digital pathology tools are improving MGRS diagnosis and patient care.
Area of Science:
- Onco-nephrology
- Renal pathology
- Molecular diagnostics
Background:
- Renal biopsy is crucial for diagnosing monoclonal gammopathy of renal significance (MGRS).
- Increasing complexity in MGRS diagnosis challenges nephrologists and pathologists.
- There is a need for better understanding of MGRS molecular landscape.
Purpose of the Study:
- To bridge the gap between clinical MGRS questions and molecular landscape.
- To provide a better characterization of MGRS entities.
- To enhance understanding of onco-nephrology.
Main Methods:
- Application of proteomic techniques, including MALDI-MS imaging.
- Utilization of next-generation digital pathology platforms.
- Review of current literature and clinical practices in MGRS.
Main Results:
- Proteomic techniques shed light on MGRS pathobiology, improving diagnosis and prognosis.
- Digital pathology enhances physician understanding through databases and improved reports.
- Advanced techniques aid in identifying sub-detectable neoplastic clones.
Conclusions:
- Proteomics and digital pathology are transforming MGRS diagnosis and management.
- These technologies offer new insights into the molecular basis of MGRS.
- Improved diagnostic accuracy and patient care are anticipated outcomes.
