What is the place of POEMS syndrome in the current classification of monoclonal gammopathies of renal significance?


light or heavy chains renal deposits, although it is possible that they could be unmasked using techniques such as paraffin immunofluorescence [6–10]. POEMS syndrome’ nephropathy is a thrombotic microangiopathy associated to humoral factors such as the vascular endothelial growth factor (VEGF). Even more, the treatment of this lymphoproliferative disorder induces serum VEGF reduction, and this phenomenon correlates positively with the glomerular filtration rate recovery [3, 7–9, 11]. Thus, based on the previously exposed reasons, we propose that the humoral factors should be included in the MGRS definition as one of the potential MGRS inducing mechanism together with the renal deposition of monoclonal Ig and renal damaging antibody activity. In conclusion, monoclonal gammopathy of renal significance should be currently defined as a hemato-nephrological meta-entity characterized by renal damage mediated by monoclonal immunoglobulin and humoral factors secreted by small clone lymphoproliferative disorders.


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