Paraprotein-related renal disease and amyloid

Paraproteins are most commonly produced by plasma cell dyscrasias. A paraprotein is frequently an incidental finding in patients with renal disease but can cause renal dysfunction directly through a variety of underlying pathological processes. Diagnosis is usually through the detection of a monoclonal protein in combination with a renal biopsy. The general supportive management of all paraprotein-related renal lesions is meticulous fluid balance, early treatment of infections and avoidance of nephrotoxins. Patients with severe renal impairment may require renal replacement therapy and selected patients can benefit from renal transplantation. Treatment with chemotherapy can halt the production of the paraprotein, which in turn may benefit renal function. Early diagnosis and use of the newer rapidly effective chemotherapy agents has improved patient and renal outcomes.