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Published on: June 18, 2020
Monoclonal gammopathy in ANCA-associated glomerulonephritis: prevalence, characteristics and outcomes
Alice Desouche1, Anne-Sophie Garnier1, Jean-Philippe Coindre2
1Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, Angers, France.
Background:
Monoclonal gammopathy (MG) is common in older individuals and may influence autoimmune diseases. Its impact in ANCA-associated glomerulonephritis (ANCA-GN) remains poorly evaluated.
Methods:
We conducted a multicenter retrospective study including 332 patients with ANCA-GN from 7 centers. MG was identified at diagnosis by serum electrophoresis and/or immunofixation. Clinical, laboratory, and histological characteristics were compared according to MG status. Outcomes including end-stage renal disease (ESRD), relapse, major cardiovascular events (MACE), severe infections, cancer, and mortality were analyzed using Kaplan-Meier analysis and factors associated with outcomes were studied using univariable and multivariable Cox regression.
Results:
Among 332 patients (median age 65 years [56-75], 59% males), MG was detected in 50 patients (15.1%). MG-positive patients tended to be older, were more frequently males, had more hypertension, and lower serum albumin levels, but similar renal function, BVAS, ANCA subtype, and histological findings compared with MG-negative patients. During a median follow-up of 57 months, MG was associated with reduced overall survival (HR 2.19, CI 1.28-3.75, p = 0.004), an increased risk of severe infections (HR 1.76, CI 1.17-2.64, p = 0.007) and an increased risk of cancer (HR 2.07, CI 1.08-3.95, p = 0.028) in univariable analyses. However, after adjustment, MG was no longer an independent predictor of mortality, infection or cancer, and was not associated with kidney-specific outcomes such as ESRD. No differences were observed for relapse, cardiovascular events (MACE), or progression to ESRD. Importantly, no patient developed multiple myeloma or related hematological malignancies during follow-up.
Conclusions:
MG is frequent in patients with ANCA-GN, mainly reflecting age and comorbidity but does not independently influence renal survival, mortality, or progression to hematological malignancy. MG should be considered a coexisting condition rather than a disease modifier in ANCA-GN, although standardized follow-up remains warranted.
Insights
Monoclonal gammopathy (MG) is common in ANCA-associated glomerulonephritis (ANCA-GN) but does not independently affect kidney survival or mortality. This finding suggests MG is a coexisting condition in ANCA-GN patients, not a disease modifier.
Area of Science:
- Nephrology
- Hematology
- Immunology
Background:
- Monoclonal gammopathy (MG) is prevalent in older adults and can impact autoimmune conditions.
- The specific influence of MG on ANCA-associated glomerulonephritis (ANCA-GN) is not well understood.
Purpose of the Study:
- To investigate the prevalence and impact of MG in patients diagnosed with ANCA-GN.
- To determine if MG affects renal outcomes, mortality, or other adverse events in ANCA-GN.
Main Methods:
- A multicenter retrospective study included 332 ANCA-GN patients.
- MG was identified at diagnosis using serum electrophoresis and/or immunofixation.
- Outcomes including end-stage renal disease (ESRD), relapse, major adverse cardiovascular events (MACE), severe infections, cancer, and mortality were analyzed.
Main Results:
- MG was detected in 15.1% of ANCA-GN patients, who were older and had more comorbidities.
- Univariable analysis showed associations between MG and reduced survival, increased infections, and cancer risk.
- After adjustment, MG was not an independent predictor for mortality, infection, cancer, or renal outcomes like ESRD.
Conclusions:
- MG is frequent in ANCA-GN, often reflecting patient age and comorbidities.
- MG does not independently influence renal survival, mortality, or progression to hematological malignancy in ANCA-GN.
- MG should be viewed as a coexisting condition rather than a disease modifier in ANCA-GN, warranting standardized follow-up.
