Monoclonal immunoglobulin deposition disease

The deposition of monoclonal immunoglobulins on the basement membrane of the kidney causes renal impairment.

As well as the kidney, MIDD may also affect the liver, heart, peripheral nerves, lung and skin.

When presenting to primary care physicians, patients with MIDD frequently have renal insufficiency, proteinuria and these symptoms are often accompanied by nephrotic syndrome, but patients may also present with acute renal failure.

Monoclonal immunoglobulins are produced in diseases that feature abnormal proliferation of plasma cells.

[5] In MIDD, these abnormal immunoglobulins, or fragments of them, are deposited along the basement membrane of the kidney.

[6] As the deposits have no organised structure, it is grouped among the non-organised monoclonal gammopathies of renal significance.

[2][8] If both types of disease co-exist, the staining may be confused, while mass spectrometry results will be more clear.

[9] The diseases vary in what part of the immunoglobulin is deposited, and which measurement techniques are most useful in aiding their diagnosis.

[2] Early treatment is recommended in MIDD to prevent or reduce irreversible kidney damage.

[2] Treatment is directed at the underlying monoclonal gammopathy,[11] and is intended to reduce the production of the monoclonal proteins[12] and may include bortezomib-based treatment, an autologous stem cell transplant, and if the patient is considered eligible, an organ transplant.

[3] MIDD is a rare disease, with incidence estimated at 1 person per million per year in Western countries.

[5] They described it as "a non-amyloid kidney disease resembling diabetic glomerulosclerosis in non-diabetic myeloma patients.