Iman Alshamsi: Thrombophilia Workup and PNH Screening When Testing Matters
Iman Alshamsi, Nephrologist at International Society of Nephrology, shared a post on LinkedIn:
“Monoclonal Gammopathy: From Detection to Prediction
I had the pleasure of speaking about monoclonal gammopathy and kidney disease at the 4th OSNT International Nephrology Conference in Salalah.
After preparing for this talk and disappearing rather deeply down the monoclonal gammopathy rabbit hole these are the messages I came away with:
- Clone size does not equal clinical significance. A small clone can cause major kidney injury. MGRS is about what the clone does, not simply how big it is.
- Start with the renal phenotype. AKI, nephrotic syndrome, CKD, hematuria and proteinuria give us clues about the monoclonal process we should be looking for.
- SPEP alone is not enough. SPEP, immunofixation, serum free light chains and urine studies each answer different questions and each has limitations.
- A negative monoclonal screen does not always exclude a monoclonal kidney disease. Sometimes the kidney biopsy detects the consequences of a clone that is very difficult to find elsewhere.
- MGUS plus kidney disease does not automatically equal MGRS. Association is not attribution. The renal lesion matters.
- Kidney biopsy remains central. It helps connect the circulating protein, the clone and the actual organ injury.
- Our ability to characterize clones and their products is rapidly improving. The future may be less about waiting for disease thresholds and more about understanding biological risk.
- And that led me to end with a slightly ambitious thought:
What if one day we could identify the dangerous clone before the kidney injury occurs?
Screen, Identify, Characterize, Predict, Treat, Prevent
Perhaps the future of MGRS is not simply becoming better at treating established disease.
Perhaps it is preventing the renal injury in the first place.
A wonderful opportunity to learn, question what I thought I knew, and share ideas with colleagues in Salalah.”
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