Suspected Monoclonal Gammopathy of Renal Significance in an HIV-Positive Patient with End-Stage Renal Disease and Non-Biopsiable Kidneys

Abstract

Background: Monoclonal gammopathy of renal significance (MGRS) describes kidney disease caused by nephrotoxic monoclonal immunoglobulins produced by small B-cell or plasma cell clones that do not meet criteria for overt hematologic malignancy. Renal biopsy is essential for definitive diagnosis but may be contraindicated in specific patient cases. This case highlights the importance of early screening, diagnosis, and treatment to prevent progression to end-stage renal disease (ESRD).

Case Presentation: A 46-year-old HIV-positive female with long-standing viral suppression on renal-friendly antiretroviral therapy presented with end-stage renal disease. Serum protein electrophoresis revealed two monoclonal paraproteins and markedly elevated immunoglobulin G levels. Extensive evaluation excluded plasma cell and lymphoproliferative neoplasms. Renal biopsy was contraindicated due to bilaterally small kidneys. A diagnosis of suspected MGRS was made, and clone-directed therapy was initiated. Although a biochemical response was achieved, renal function did not recover.

Conclusion: This case highlights the diagnostic and therapeutic challenges of suspected MGRS in patients presenting with advanced renal disease where histologic confirmation is not feasible, emphasizing the importance of early recognition to prevent irreversible kidney injury.

Citation

Juby-Ebersey Jade, Shira K, Siddeeq H, Nadine R. Suspected Monoclonal Gammopathy of Renal Significance in an HIV-Positive Patient with End-Stage Renal Disease and Non-Biopsiable Kidneys. WebLog J Nephrol. wjnp.2026. e1807. https://doi.org/10.5281/zenodo.20337071