Paraprotein-associated thrombotic microangiopathy: expanding the spectrum of renal disease related to plasma cell dyscrasias.

Plasma cell dyscrasias are associated with a variety of renal diseases, most resulting from the deposition of intact or altered monoclonal paraproteins within the renal parenchyma. Much less commonly, renal disease resulting from monoclonal gammopathies has been reported without actual accumulation of the paraprotein or a derivative of it within the kidney. One such instance involves thrombotic microangiopathy (TMA), which is a consequence of endothelial cell injury. New data from the Mayo Clinic indicate that the association of TMA with monoclonal gammopathies is far more frequent than previously appreciated. These findings have potentially important implications for the treatment of TMA in a significant number of patients.