Transient Monoclonal Gammopathy Associated With Cytomegalovirus Infection

Vodopick, H.; Chaskes, Stuart; Solomon, Alan; Stewart, John A.

doi:10.1182/blood.v44.2.189.189

Cited by 38 publications

(5 citation statements)

References 12 publications

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“…CMV infection has been evidenced in two of four control‐transplanted patients with gammopathy and in zero of seven control patients without gammopathy. CMV infection testing has been limited in our retrospective study, but our observation supports that of others where CMV infection has been associated with transient gammopathy appearance in transplanted patients (38, 39, 43–46). Indeed, CMV infection activates B cells and depresses cell‐mediated immunity (47, 48).…”

Section: Discussionsupporting

confidence: 91%

Associations of serum EBV DNA and gammopathy with post‐transplant lymphoproliferative disease

Rosselet

Meylan³

et al. 2009

Clinical Transplantation

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Section: Discussionsupporting

confidence: 91%

Associations of serum EBV DNA and gammopathy with post‐transplant lymphoproliferative disease

Rosselet

Meylan³

et al. 2009

Clinical Transplantation

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“…Of interest, we identified development of a monoclonal dysproteinemia occurring concurrently with PyVAN in two patients. A transient monoclonal gammopathy has been reported previously in a patient with CMV infection . The clinical significance of our findings cannot be ascertained at this time, but highlights the prominent role of plasma cells in PyVAN, presumably related to this phenomenon.…”

Section: Discussioncontrasting

confidence: 49%

Histological Evolution of BK Virus–Associated Nephropathy: Importance of Integrating Clinical and Pathological Findings

Drachenberg

Chaudhry

Ugarte

et al. 2017

American Journal of Transplantation

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Long-term clinicopathological studies of BK-associated nephropathy (PyVAN) are not available. We studied 206 biopsies (71 patients), followed 3.09 ± 1.46 years after immunosuppression reduction. The biopsy features (% immunostain for PyV large T ag + staining and inflammation ± acute rejection) were correlated with viral load dynamics and serum creatinine to define the clinicopathological status (PyVCPS). Incidence of acute rejection was 28% in the second biopsy and 50% subsequently (25% mixed T cell-mediated allograft rejection (TCMR) + antibody-mediated allograft rejection (AMR); rejection overall affected 38% of patients (>50% AMR). Graft loss was 15.4% (0.8-5.3 years after PyVAN); 76% had complete viral clearance (mean 28 weeks). The only predictors of graft loss were acute rejection (TCMR p = 0.008, any type p = 0.07), and increased "t" and "ci" in the second biopsy (p = 0.006 and 0.048). Higher peak viremia correlated with poorer viral clearance (p = 0.002). Presumptive and proven PyVAN had similar presentation, evolution, and outcome. Late PyVAN (>2 years, 9.8%) justifies BK viremia evaluation at any point with graft dysfunction and/or biopsy evaluation. This study describes the histological evolution of PyVAN and corresponding clinicopathological correlations. Although the pathological features overall reflect the viral and immunological interactions, the PyVAN course remains difficult to predict based on any single feature. Appropriate clinical management requires repeat biopsies and determination of the PyVCPS at relevant time points, for corresponding personalized immunosuppression adjustment.

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“…Transient paraproteinemia has been reported in the setting of various infectious and autoimmune diseases 70 , 71 , 72 . While not previously described, it is possible that SARS-CoV-2 can induce transient paraproteinemia due to hyperactivity of the immune system in response to infection.…”

Section: Discussionmentioning

confidence: 99%

“…While not previously described, it is possible that SARS-CoV-2 can induce transient paraproteinemia due to hyperactivity of the immune system in response to infection. Transient paraproteinemia has also been associated with kidney dysfunction 70 . It is unknown whether this accounts for the increased frequency of proliferative glomerulonephritis with monoclonal IgG deposits in COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

A multi-center retrospective cohort study defines the spectrum of kidney pathology in Coronavirus 2019 Disease (COVID-19)

May

Cassol

Hannoudi

et al. 2021

Kidney International

110

139

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Kidney failure is common in patients with Coronavirus Disease-19 (COVID-19) resulting in increased morbidity and mortality. In an international collaboration, 284 kidney biopsies were evaluated to improve understanding of kidney disease in COVID-19. Diagnoses were compared to five years of 63,575 native biopsies prior to the pandemic and 13,955 allograft biopsies to identify diseases increased in patients with COVID-19. Genotyping for APOL1 G1 and G2 alleles was performed in 107 African American and Hispanic patients. Immunohistochemistry for SARS-CoV-2 was utilized to assess direct viral infection in 273 cases along with clinical information at the time of biopsy. The leading indication for native biopsy was acute kidney injury (45.4%), followed by proteinuria with or without concurrent acute kidney injury (42.6%). There were more African American patients (44.6%) than patients of other ethnicities. The most common diagnosis in native biopsies was collapsing glomerulopathy (25.8%) which associated with high-risk APOL1 genotypes in 91.7% of cases. Compared to the five-year biopsy database, the frequency of myoglobin cast nephropathy and proliferative glomerulonephritis with monoclonal IgG deposits was also increased in patients with COVID-19 (3.3% and 1.7%, respectively), while there was a reduced frequency of chronic conditions (including diabetes mellitus, IgA nephropathy, and arterionephrosclerosis) as the primary diagnosis. In transplants, the leading indication was acute kidney injury (86.4%), for which rejection was the predominant diagnosis (61.4%). Direct SARS-CoV-2 viral infection was not identified. Thus, our multi-center large case series identified kidney diseases that disproportionately affect patients with COVID-19, demonstrated a high frequency of APOL1 high-risk genotypes within this group, with no evidence of direct viral infection within the kidney.

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Transient Monoclonal Gammopathy Associated With Cytomegalovirus Infection

Cited by 38 publications

References 12 publications

Associations of serum EBV DNA and gammopathy with post‐transplant lymphoproliferative disease

Associations of serum EBV DNA and gammopathy with post‐transplant lymphoproliferative disease

Histological Evolution of BK Virus–Associated Nephropathy: Importance of Integrating Clinical and Pathological Findings

A multi-center retrospective cohort study defines the spectrum of kidney pathology in Coronavirus 2019 Disease (COVID-19)

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