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The progression rate to a malignancy is 1&#37;&#47;year&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Monoclonal gammopathy of uncertain significance is a very frequent entity&#44; occurring in a 3&#37; of the population of more than 50 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> The diagnosis requires 3 criteria&#58; monoclonal component inferior to 3<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; less than 10&#37; of plasma cells in the bone marrow and no evidence of organic involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The monoclonal gammopathy by itself may produce different pathologies not related to the clonal mass but with characteristics of the monoclonal protein&#44; this is called monoclonal gammopathy of clinical significance&#46; The organs more frequently affected are&#58; kidney&#44; nervous system&#44; skin&#44; eye&#46;&#46;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The monoclonal gammopathy of renal significance &#40;MGRS&#41;&#44; includes all renal diseases caused by a monoclonal gammopathy &#40;without associated neoplastic disease&#41;&#46; The spectrum of MGRS is very broad and includes a recent entity such as C3 nephropathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> To date&#44; there is limited information about the occurrence of this disease after kidney transplantation&#46; Here we present 3 cases of de novo C3 nephropathy after renal transplantation in the context of a MGRS&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Description of cases</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case 1</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 66-year-old woman with chronic kidney disease stage 5 secondary to PKD due to mutation of the PKD1 gene&#46; Hemodialysis was started at 48 years&#46; Five years later&#44; she received a first kidney transplant from a cadaveric donor&#44; and induction immunosuppression was performed with prednisone&#44; tacrolimus and mycophenolate mofetil&#46; A correct function of the renal graft is achieved with a serum creatinine around 100&#8211;120<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;L and without proteinuria&#46; Seven years after renal transplantation &#40;June 2012&#41; there is evidence of proteinuria of 3<span class="elsevierStyleHsp" style=""></span>g&#47;day along with a slight deterioration of renal function&#46; For this reason&#44; a renal biopsy was performed showing global and diffuse mesangial and endocapillary proliferative glomerulonephritis&#44; with negative immunofluorescence &#40;IF&#41;&#46; With this result&#44; treatment with ACE inhibitors was started&#44; stabilizing proteinuria and renal function for 2 years&#44; subsequently there was a rapidly worsening renal function with increasing proteinuria up to 6<span class="elsevierStyleHsp" style=""></span>g&#47;day&#46; A new renal biopsy was performed showing generalized endocapillary proliferative glomerulonephritis with an IFTA of 20&#37;&#44; IF positive for C3 in the loops and mesangium&#44; leading to the diagnosis of C3 nephropathy&#46; A proteinogram showed a monoclonal IgA lamda component &#40;quantification&#58; 3<span class="elsevierStyleHsp" style=""></span>g&#47;L&#41; with negative PBJ and a normal ratio of light chains K&#47;L in serum&#46; The bone marrow aspirate shows 4&#37; of plasma cells&#46; Complement is normal and the genetic study of the complement does not show mutations&#46; Presently the renal function is very deteriorated so no specific treatment is performed and requires maintenance dialysis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case 2</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 75-year-old patient with chronic kidney disease stage 5 of unknown cause &#40;without proteinuria&#41;&#46; He started peritoneal dialysis at the age of 59&#46; After 5 years&#44; he received a first kidney transplant from a cadaveric donor&#44; and induction immunosuppression was performed with thymoglobulin&#44; prednisone&#44; mycophenolate mofetil and delayed tacrolimus&#46; Proper renal function is achieved with serum creatinine of 130&#8211;150<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;L without proteinuria&#46; After 6 years of the transplant&#44; the patient presented proteinuria of 1<span class="elsevierStyleHsp" style=""></span>g&#47;day with stable renal function&#44; so renal biopsy was performed&#46; The biopsy demonstrates segmental and diffuse mesangial and endocapillary proliferative glomerulonephritis&#44; and a definitive diagnosis cannot be established due to the lack of glomeruli to perform IF&#46; Treatment with ACEI is started&#44; achieving stabilization of proteinuria&#46; Three years later proteinuria sharply increased to 5<span class="elsevierStyleHsp" style=""></span>g&#47;day and renal function was deteriorated to serum creatinine levels of 200<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;L&#46; Thus&#44; a new renal biopsy was performed showing mesangial and endocapillary proliferative glomerulonephritis generalized with IFTA of 20&#37; and the IF demonstrated mesangial and subendothelial C3 deposits&#44; making the diagnosis of C3 nephropathy&#46; The proteinogram presented monoclonal component IgM kappa &#40;quantification&#58; 2&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;L&#41; with negative PBJ and normal ratio K&#47;L light chains in serum&#46; The bone marrow aspirate showed 2&#37; of plasma cells&#46; The complement was normal and no mutations could be characterized but it was evidenced the presence of antifactor H antibodies&#46; It was decided to perform treatment with rituximab &#40;single dose of 1<span class="elsevierStyleHsp" style=""></span>g&#41; with good initial response&#44; proteinuria and renal function was stabilized for a few months&#44; but later renal function deteriorated requiring hemodialysis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Case 3</span><p id="par0035" class="elsevierStylePara elsevierViewall">A 56-year-old man with chronic kidney disease stage 5 of unknown cause &#40;without proteinuria&#41;&#46; Hemodialysis started at the age of 49&#46; After 6 years&#44; he received a first kidney transplant from a cadaver donor&#44; and induction immunosuppression was performed with thymoglobulin&#44; prednisone&#44; mycophenolate mofetil and delayed tacrolimus&#46; Renal graft function improves to serum creatinine 160&#8211;170<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;L without proteinuria&#46; One year after transplantation&#44; he presented a proteinuria of 1&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;day&#59; the renal biopsy showed acute borderline cell rejection with moderate IFTA&#46; It was decided to maintain immunosuppression in the high range and treatment with ACEI was started&#44; maintaining a stable proteinuria&#46; Four years later&#44; proteinuria increased very severely to 9<span class="elsevierStyleHsp" style=""></span>g&#47;day without nephrotic syndrome and renal function decreased rapidly to serum creatinine 300<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#46; A renal biopsy was performed showing focal and segmental mesangial and endocapillary proliferative glomerulonephritis with IFTA of 50 and a 30&#37; of glomerular sclerosis&#46; Congo Red staining is negative&#46; IF showed gross granular deposit of C3 in loops and mesangium making the diagnosis of C3 nephropathy&#46; The proteinogram showed monoclonal component IgG kappa &#40;quantification&#58; 1&#46;6<span class="elsevierStyleHsp" style=""></span>g&#47;L&#41; with a normal ratio of K&#47;L light chains in serum and a bone marrow aspirate with 5&#37; of plasma cells&#46; The complement was normal and the genetic study was negative Due to important IFTA and glomerular sclerosis in the biopsy and since the renal function worsens rapidly&#44; no specific treatment was performed and the patient was started again on regular hemodialysis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The monoclonal gammopathy of renal significance includes all forms of renal involvement caused by a monoclonal immunoglobulin secreted by a non-malignant B-cell clone &#40;without associated neoplastic disease&#41;&#46; Kidney involvement is diverse and may be very severe in some cases&#46; It implies a high morbidity&#44; which is why it is important to come out with an early diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> Regarding the pathogenesis&#44; kidney involvement may occur through two mechanisms&#46; A direct mechanism&#44; due to the deposit of the immunoglobulin or monoclonal immunoglobulin chain at the level of the glomerulus or the tubule&#46; This would be the mechanism underlying the AL amyloidosis&#44; the disease due to light chain deposits or the fibrillar and immunotactoid glomerulonephritis&#46; The other mechanism is indirect&#44; the monoclonal gammopathy produces a dysregulation of the alternative pathway of the complement causing a continued activation of this pathway&#46; In this case&#44; if the lesions are at the glomerular level it is a C3 nephropathy that includes C3 glomerulonephritis and the dense deposits disease&#59; if the lesions affect the vessels it is an atypical HUS&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Focusing on C3 nephropathy&#44; the main diagnostic hypothesis is that the monoclonal protein would interfere with the proteins that regulate complement function&#44; mainly the H factor&#46; The monoclonal protein would act as an autoantibody against factor H&#44; causing its inhibition causing a continuous activation of the alternative pathway of the complement that would produce glomerular damage&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Both in C3 glomerulonephritis and in dense deposits disease&#44; mesangial&#44; membranoproliferative and endocapillary proliferation occurs with granular deposits of C3 at the glomerular level and the absence of immunoglobulin deposits&#46; The difference between the 2 entities is observed by electron microscopy where in the case of C3 glomerulonephritis some granular deposit is observed at subendothelial&#44; subepithelial or mesangial level and in dense deposits disease these deposits are seen in mesangium and infiltrating the glomerular basement membrane&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The presentation of these pathologies is usually proteinuria&#46; This may often progress to a nephrotic range&#46; In the absence of specific treatment&#44; there is a progressive deterioration of renal function and shortly after the patient requires renal replacement therapy&#46; The diagnosis is made by renal biopsy&#44; and it essential to perform IF and&#44; if possible&#44; the electronic microscopy&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">There is little experience about the treatment of the MGRS&#44; so it is not standardized yet&#46; The treatment is based on the use of chemotherapy&#46; In normal clinical practice&#44; sometimes&#44; it is difficult to encourage haematologists to perform this type of treatment in the absence of a basic neoplastic process&#46; If the monoclonal component is IgM&#44; the most accepted treatment at the present time is the use rituximab with or without cyclophosphamide&#46; If the monoclonal component is IgA or IgG&#44; it is advised the use of bortezomib associated or not to cyclophosphamide&#46; However&#44; it is evident that it is necessary to have more experience on these pathologies to establish treatment guidelines and to learn from the long-term prognosis of these entities on these treatments&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">From our experience&#44; making an early diagnosis is essential in order to effectively apply a specific treatment&#46; In cases 1 and 3&#44; the renal function was already very deteriorated at the time of diagnosis&#44; thus no specific treatment was prescribed&#46; In case 2&#44; the biopsy showed little fibrosis and given the fact that monoclonal component was IgM&#44; it was decided use rituximab&#44; achieving a partial but temporary response&#44; probably due to its late application&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding the possibility of a new transplant of patients who have lost the graft due to this pathology&#44; it could be performed&#44; but with a very close follow-up in the post-transplant&#44; both due to the possibility of recurrence of the kidney disease and the possibility of progression to malignancy&#46; of gammapathy&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="par0075" class="elsevierStylePara elsevierViewall">The monoclonal gammopathy of renal significance in the form of C3 nephropathy after kidney transplantation is narrowly described so far&#46; It usually manifests in the form of nephrotic proteinuria with subsequent deterioration of renal function&#44; which can lead to loss of the graft in a short time&#46; In this context&#44; it is very important to perform the diagnosis early in order to apply a specific treatment with chemotherapy at the initial phases of the disease&#46; However&#44; the most appropriate treatment guidelines for each specific clinical situation are still not well defined&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            2 => "C3 glomerulopathy"
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            0 => "Gammapat&#237;a monoclonal"
            1 => "Trasplante renal"
            2 => "Nefropat&#237;a C3"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Monoclonal gammopathy of renal significance includes all renal disorders caused by a monoclonal immunoglobulin secreted by a non-malignant B-cell clone&#46; Patients with MGRS do not&#44; by definition&#44; meet criteria for multiple myeloma&#44; with haematological disorders generally considered to be monoclonal gammopathy of undetermined significance&#46; Nevertheless&#44; the renal involvement can be serious and require specific treatment&#46; Monoclonal gammopathy of renal significance is associated with a wide spectrum of disorders&#44; including the recently discovered C3 glomerulopathy&#46; Development of C3 glomerulopathy in the context of monoclonal gammopathy of renal significance after kidney transplantation is uncommon and very few cases have been published to date&#46; We report on three cases of C3 glomerulopathy in the context of de novo monoclonal gammopathy after kidney transplantation&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La gammapat&#237;a monoclonal de significado renal incluye todas las enfermedades renales causadas por una inmunoglobulina monoclonal secretada por un clon de c&#233;lula B no maligno&#46; Por definici&#243;n&#44; los pacientes con gammapat&#237;a monoclonal de significado renal no cumplen criterios de mieloma m&#250;ltiple y la alteraci&#243;n hematol&#243;gica es generalmente considerada gammapat&#237;a monoclonal de significado incierto&#46; No obstante&#44; la dolencia que pueden causar a nivel renal puede ser importante&#44; requiriendo un tratamiento espec&#237;fico&#46; El espectro de la gammapat&#237;a monoclonal de significado renal es amplio&#44; incluyendo una entidad reciente como la nefropat&#237;a C3&#46; El desarrollo de una nefropat&#237;a C3 en el contexto de una gammapat&#237;a monoclonal de significado renal tras el trasplante renal no es frecuente y hasta el momento ha sido poco descrita&#46; A continuaci&#243;n presentamos 3 casos de nefropat&#237;a C3 asociados a una gammapat&#237;a monoclonal de aparici&#243;n de novo tras el trasplante renal&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Serra N&#44; Facundo C&#44; Canal C&#44; Arce Y&#44; Ayasreh N&#44; Vila A&#44; et al&#46; Tres casos de gammapat&#237;a monoclonal de significado renal postrasplante renal&#58; nefropat&#237;a c3 de novo&#46; Nefrologia&#46; 2019&#59;39&#58;198&#8211;201&#46;</p>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">MC&#58; type of monoclonal component&#59; time MGRS-DI&#58; time from the diagnosis of MGRS to the start of dialysis &#40;years&#41;&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Time TR-MGRS&#58; time of renal transplantation until the diagnosis of MGRS &#40;years&#41;&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Cause of CKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time TR-MGRS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Specific Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time MGRS-DI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Case 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IgA lambda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Case 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IgM kappa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rituximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Case 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IgG kappa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 months&nbsp;\t\t\t\t\t\t\n
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Criteria for the classification of monoclonal gammopathies&#44; multiple mieloma and related disorders&#58; a report of the International Myeloma Working group"
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                        0 => array:2 [
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                      "Revista" => array:6 [
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                        "paginaInicial" => "749"
                        "paginaFinal" => "757"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12780789"
                            "web" => "Medline"
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              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathogenesis and progression of monoclonal gammopathy of undetermined significance"
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                        0 => array:2 [
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                          "autores" => array:4 [
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                            1 => "L&#46; Rosi&#241;ol"
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                            3 => "C&#46;F&#46; de larrea"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/leu.2008.203"
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                        "tituloSerie" => "Leukemia"
                        "fecha" => "2008"
                        "volumen" => "22"
                        "paginaInicial" => "1651"
                        "paginaFinal" => "1657"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18668131"
                            "web" => "Medline"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of monoclonal gammopathy of undetermined significance"
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                        0 => array:2 [
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                            1 => "T&#46;M&#46; Therneau"
                            2 => "S&#46;V&#46; Rajkumar"
                            3 => "D&#46;R&#46; Larson"
                            4 => "M&#46;F&#46; Plevak"
                            5 => "J&#46;R&#46; Offord"
                          ]
                        ]
                      ]
                    ]
                  ]
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                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2006"
                        "volumen" => "354"
                        "paginaInicial" => "1362"
                        "paginaFinal" => "1369"
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                          ]
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                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Best Pract Res Clin Haematol"
                        "fecha" => "2005"
                        "volumen" => "18"
                        "paginaInicial" => "689"
                        "paginaFinal" => "707"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monoclonal gammopathy&#58; the good&#44; the bad and the ugly"
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                            0 => "S&#46;V&#46; Glavey"
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                    ]
                  ]
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                        "paginaFinal" => "231"
                      ]
                    ]
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                ]
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                      "Revista" => array:5 [
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                        "paginaFinal" => "137"
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                    ]
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                    0 => array:2 [
                      "titulo" => "International Kidney and Monoclonal Gammopathy Research Group&#58; diagnosis of monoclonal gammopathy of renal significance"
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                            4 => "S&#46; Sethi"
                            5 => "J&#46;P&#46; Fermand"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ki.2014.408"
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                        "tituloSerie" => "Kidney Int"
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                        "link" => array:1 [
                          0 => array:2 [
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Case report
Three cases of monoclonal gammopathy of renal significance after kidney transplantation. De novo C3 glomerulopathy
Tres casos de gammapatía monoclonal de significado renal postrasplante renal: nefropatía c3 de novo
Núria Serraa,
Corresponding author
nserra@fundacio-puigvert.es

Corresponding author.
, Carme Facundoa, Cristina Canala, Yolanda Arceb, Nadia Ayasreha, Anna Vilaa, Beatriz Bardajía, Irene Silvaa, Víctor Lópeza, Silvia Benitoa, Jose Ballarína, Lluís Guiradoa
a Servicio de Nefrología, Unidad de Trasplante Renal, Fundació Puigvert, Barcelona, Spain
b Servicio de Anatomía Patológica, Fundació Puigvert, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Monoclonal gammopathy is the proliferation of the B lymphocyte cell line that produces a monoclonal immunoglobulin or its fragment &#40;light chain or heavy chain&#41;&#46; Different haematological conditions may produce a monoclonal gammopathy&#58; monoclonal gammopathy of uncertain significance&#44; multiple myeloma&#44; plasmacytoma&#44; Waldenstr&#246;m macroglobulinemia&#44; chronic lymphatic leukaemia and lymphomas&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Monoclonal gammopathy of uncertain significance consists of the presence of a monoclonal gammopathy without an associated malignancy but it may be the precursor of malignancies such as multiple myeloma or lymphoma&#46; The progression rate to a malignancy is 1&#37;&#47;year&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Monoclonal gammopathy of uncertain significance is a very frequent entity&#44; occurring in a 3&#37; of the population of more than 50 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> The diagnosis requires 3 criteria&#58; monoclonal component inferior to 3<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; less than 10&#37; of plasma cells in the bone marrow and no evidence of organic involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The monoclonal gammopathy by itself may produce different pathologies not related to the clonal mass but with characteristics of the monoclonal protein&#44; this is called monoclonal gammopathy of clinical significance&#46; The organs more frequently affected are&#58; kidney&#44; nervous system&#44; skin&#44; eye&#46;&#46;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The monoclonal gammopathy of renal significance &#40;MGRS&#41;&#44; includes all renal diseases caused by a monoclonal gammopathy &#40;without associated neoplastic disease&#41;&#46; The spectrum of MGRS is very broad and includes a recent entity such as C3 nephropathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> To date&#44; there is limited information about the occurrence of this disease after kidney transplantation&#46; Here we present 3 cases of de novo C3 nephropathy after renal transplantation in the context of a MGRS&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Description of cases</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case 1</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 66-year-old woman with chronic kidney disease stage 5 secondary to PKD due to mutation of the PKD1 gene&#46; Hemodialysis was started at 48 years&#46; Five years later&#44; she received a first kidney transplant from a cadaveric donor&#44; and induction immunosuppression was performed with prednisone&#44; tacrolimus and mycophenolate mofetil&#46; A correct function of the renal graft is achieved with a serum creatinine around 100&#8211;120<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;L and without proteinuria&#46; Seven years after renal transplantation &#40;June 2012&#41; there is evidence of proteinuria of 3<span class="elsevierStyleHsp" style=""></span>g&#47;day along with a slight deterioration of renal function&#46; For this reason&#44; a renal biopsy was performed showing global and diffuse mesangial and endocapillary proliferative glomerulonephritis&#44; with negative immunofluorescence &#40;IF&#41;&#46; With this result&#44; treatment with ACE inhibitors was started&#44; stabilizing proteinuria and renal function for 2 years&#44; subsequently there was a rapidly worsening renal function with increasing proteinuria up to 6<span class="elsevierStyleHsp" style=""></span>g&#47;day&#46; A new renal biopsy was performed showing generalized endocapillary proliferative glomerulonephritis with an IFTA of 20&#37;&#44; IF positive for C3 in the loops and mesangium&#44; leading to the diagnosis of C3 nephropathy&#46; A proteinogram showed a monoclonal IgA lamda component &#40;quantification&#58; 3<span class="elsevierStyleHsp" style=""></span>g&#47;L&#41; with negative PBJ and a normal ratio of light chains K&#47;L in serum&#46; The bone marrow aspirate shows 4&#37; of plasma cells&#46; Complement is normal and the genetic study of the complement does not show mutations&#46; Presently the renal function is very deteriorated so no specific treatment is performed and requires maintenance dialysis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case 2</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 75-year-old patient with chronic kidney disease stage 5 of unknown cause &#40;without proteinuria&#41;&#46; He started peritoneal dialysis at the age of 59&#46; After 5 years&#44; he received a first kidney transplant from a cadaveric donor&#44; and induction immunosuppression was performed with thymoglobulin&#44; prednisone&#44; mycophenolate mofetil and delayed tacrolimus&#46; Proper renal function is achieved with serum creatinine of 130&#8211;150<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;L without proteinuria&#46; After 6 years of the transplant&#44; the patient presented proteinuria of 1<span class="elsevierStyleHsp" style=""></span>g&#47;day with stable renal function&#44; so renal biopsy was performed&#46; The biopsy demonstrates segmental and diffuse mesangial and endocapillary proliferative glomerulonephritis&#44; and a definitive diagnosis cannot be established due to the lack of glomeruli to perform IF&#46; Treatment with ACEI is started&#44; achieving stabilization of proteinuria&#46; Three years later proteinuria sharply increased to 5<span class="elsevierStyleHsp" style=""></span>g&#47;day and renal function was deteriorated to serum creatinine levels of 200<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;L&#46; Thus&#44; a new renal biopsy was performed showing mesangial and endocapillary proliferative glomerulonephritis generalized with IFTA of 20&#37; and the IF demonstrated mesangial and subendothelial C3 deposits&#44; making the diagnosis of C3 nephropathy&#46; The proteinogram presented monoclonal component IgM kappa &#40;quantification&#58; 2&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;L&#41; with negative PBJ and normal ratio K&#47;L light chains in serum&#46; The bone marrow aspirate showed 2&#37; of plasma cells&#46; The complement was normal and no mutations could be characterized but it was evidenced the presence of antifactor H antibodies&#46; It was decided to perform treatment with rituximab &#40;single dose of 1<span class="elsevierStyleHsp" style=""></span>g&#41; with good initial response&#44; proteinuria and renal function was stabilized for a few months&#44; but later renal function deteriorated requiring hemodialysis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Case 3</span><p id="par0035" class="elsevierStylePara elsevierViewall">A 56-year-old man with chronic kidney disease stage 5 of unknown cause &#40;without proteinuria&#41;&#46; Hemodialysis started at the age of 49&#46; After 6 years&#44; he received a first kidney transplant from a cadaver donor&#44; and induction immunosuppression was performed with thymoglobulin&#44; prednisone&#44; mycophenolate mofetil and delayed tacrolimus&#46; Renal graft function improves to serum creatinine 160&#8211;170<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;L without proteinuria&#46; One year after transplantation&#44; he presented a proteinuria of 1&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;day&#59; the renal biopsy showed acute borderline cell rejection with moderate IFTA&#46; It was decided to maintain immunosuppression in the high range and treatment with ACEI was started&#44; maintaining a stable proteinuria&#46; Four years later&#44; proteinuria increased very severely to 9<span class="elsevierStyleHsp" style=""></span>g&#47;day without nephrotic syndrome and renal function decreased rapidly to serum creatinine 300<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#46; A renal biopsy was performed showing focal and segmental mesangial and endocapillary proliferative glomerulonephritis with IFTA of 50 and a 30&#37; of glomerular sclerosis&#46; Congo Red staining is negative&#46; IF showed gross granular deposit of C3 in loops and mesangium making the diagnosis of C3 nephropathy&#46; The proteinogram showed monoclonal component IgG kappa &#40;quantification&#58; 1&#46;6<span class="elsevierStyleHsp" style=""></span>g&#47;L&#41; with a normal ratio of K&#47;L light chains in serum and a bone marrow aspirate with 5&#37; of plasma cells&#46; The complement was normal and the genetic study was negative Due to important IFTA and glomerular sclerosis in the biopsy and since the renal function worsens rapidly&#44; no specific treatment was performed and the patient was started again on regular hemodialysis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The monoclonal gammopathy of renal significance includes all forms of renal involvement caused by a monoclonal immunoglobulin secreted by a non-malignant B-cell clone &#40;without associated neoplastic disease&#41;&#46; Kidney involvement is diverse and may be very severe in some cases&#46; It implies a high morbidity&#44; which is why it is important to come out with an early diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> Regarding the pathogenesis&#44; kidney involvement may occur through two mechanisms&#46; A direct mechanism&#44; due to the deposit of the immunoglobulin or monoclonal immunoglobulin chain at the level of the glomerulus or the tubule&#46; This would be the mechanism underlying the AL amyloidosis&#44; the disease due to light chain deposits or the fibrillar and immunotactoid glomerulonephritis&#46; The other mechanism is indirect&#44; the monoclonal gammopathy produces a dysregulation of the alternative pathway of the complement causing a continued activation of this pathway&#46; In this case&#44; if the lesions are at the glomerular level it is a C3 nephropathy that includes C3 glomerulonephritis and the dense deposits disease&#59; if the lesions affect the vessels it is an atypical HUS&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Focusing on C3 nephropathy&#44; the main diagnostic hypothesis is that the monoclonal protein would interfere with the proteins that regulate complement function&#44; mainly the H factor&#46; The monoclonal protein would act as an autoantibody against factor H&#44; causing its inhibition causing a continuous activation of the alternative pathway of the complement that would produce glomerular damage&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Both in C3 glomerulonephritis and in dense deposits disease&#44; mesangial&#44; membranoproliferative and endocapillary proliferation occurs with granular deposits of C3 at the glomerular level and the absence of immunoglobulin deposits&#46; The difference between the 2 entities is observed by electron microscopy where in the case of C3 glomerulonephritis some granular deposit is observed at subendothelial&#44; subepithelial or mesangial level and in dense deposits disease these deposits are seen in mesangium and infiltrating the glomerular basement membrane&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The presentation of these pathologies is usually proteinuria&#46; This may often progress to a nephrotic range&#46; In the absence of specific treatment&#44; there is a progressive deterioration of renal function and shortly after the patient requires renal replacement therapy&#46; The diagnosis is made by renal biopsy&#44; and it essential to perform IF and&#44; if possible&#44; the electronic microscopy&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">There is little experience about the treatment of the MGRS&#44; so it is not standardized yet&#46; The treatment is based on the use of chemotherapy&#46; In normal clinical practice&#44; sometimes&#44; it is difficult to encourage haematologists to perform this type of treatment in the absence of a basic neoplastic process&#46; If the monoclonal component is IgM&#44; the most accepted treatment at the present time is the use rituximab with or without cyclophosphamide&#46; If the monoclonal component is IgA or IgG&#44; it is advised the use of bortezomib associated or not to cyclophosphamide&#46; However&#44; it is evident that it is necessary to have more experience on these pathologies to establish treatment guidelines and to learn from the long-term prognosis of these entities on these treatments&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">From our experience&#44; making an early diagnosis is essential in order to effectively apply a specific treatment&#46; In cases 1 and 3&#44; the renal function was already very deteriorated at the time of diagnosis&#44; thus no specific treatment was prescribed&#46; In case 2&#44; the biopsy showed little fibrosis and given the fact that monoclonal component was IgM&#44; it was decided use rituximab&#44; achieving a partial but temporary response&#44; probably due to its late application&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding the possibility of a new transplant of patients who have lost the graft due to this pathology&#44; it could be performed&#44; but with a very close follow-up in the post-transplant&#44; both due to the possibility of recurrence of the kidney disease and the possibility of progression to malignancy&#46; of gammapathy&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="par0075" class="elsevierStylePara elsevierViewall">The monoclonal gammopathy of renal significance in the form of C3 nephropathy after kidney transplantation is narrowly described so far&#46; It usually manifests in the form of nephrotic proteinuria with subsequent deterioration of renal function&#44; which can lead to loss of the graft in a short time&#46; In this context&#44; it is very important to perform the diagnosis early in order to apply a specific treatment with chemotherapy at the initial phases of the disease&#46; However&#44; the most appropriate treatment guidelines for each specific clinical situation are still not well defined&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "identificador" => "sec0010"
          "titulo" => "Description of cases"
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    "fechaRecibido" => "2018-01-15"
    "fechaAceptado" => "2018-03-22"
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          "clase" => "keyword"
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            0 => "Monoclonal gammopathy"
            1 => "Kidney transplant"
            2 => "C3 glomerulopathy"
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            0 => "Gammapat&#237;a monoclonal"
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            2 => "Nefropat&#237;a C3"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Monoclonal gammopathy of renal significance includes all renal disorders caused by a monoclonal immunoglobulin secreted by a non-malignant B-cell clone&#46; Patients with MGRS do not&#44; by definition&#44; meet criteria for multiple myeloma&#44; with haematological disorders generally considered to be monoclonal gammopathy of undetermined significance&#46; Nevertheless&#44; the renal involvement can be serious and require specific treatment&#46; Monoclonal gammopathy of renal significance is associated with a wide spectrum of disorders&#44; including the recently discovered C3 glomerulopathy&#46; Development of C3 glomerulopathy in the context of monoclonal gammopathy of renal significance after kidney transplantation is uncommon and very few cases have been published to date&#46; We report on three cases of C3 glomerulopathy in the context of de novo monoclonal gammopathy after kidney transplantation&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La gammapat&#237;a monoclonal de significado renal incluye todas las enfermedades renales causadas por una inmunoglobulina monoclonal secretada por un clon de c&#233;lula B no maligno&#46; Por definici&#243;n&#44; los pacientes con gammapat&#237;a monoclonal de significado renal no cumplen criterios de mieloma m&#250;ltiple y la alteraci&#243;n hematol&#243;gica es generalmente considerada gammapat&#237;a monoclonal de significado incierto&#46; No obstante&#44; la dolencia que pueden causar a nivel renal puede ser importante&#44; requiriendo un tratamiento espec&#237;fico&#46; El espectro de la gammapat&#237;a monoclonal de significado renal es amplio&#44; incluyendo una entidad reciente como la nefropat&#237;a C3&#46; El desarrollo de una nefropat&#237;a C3 en el contexto de una gammapat&#237;a monoclonal de significado renal tras el trasplante renal no es frecuente y hasta el momento ha sido poco descrita&#46; A continuaci&#243;n presentamos 3 casos de nefropat&#237;a C3 asociados a una gammapat&#237;a monoclonal de aparici&#243;n de novo tras el trasplante renal&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Serra N&#44; Facundo C&#44; Canal C&#44; Arce Y&#44; Ayasreh N&#44; Vila A&#44; et al&#46; Tres casos de gammapat&#237;a monoclonal de significado renal postrasplante renal&#58; nefropat&#237;a c3 de novo&#46; Nefrologia&#46; 2019&#59;39&#58;198&#8211;201&#46;</p>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">MC&#58; type of monoclonal component&#59; time MGRS-DI&#58; time from the diagnosis of MGRS to the start of dialysis &#40;years&#41;&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Time TR-MGRS&#58; time of renal transplantation until the diagnosis of MGRS &#40;years&#41;&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Cause of CKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time TR-MGRS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Specific Treatment&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Case 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IgA lambda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Case 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IgM kappa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rituximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Case 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IgG kappa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Relevant clinical data&#46;</p>"
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        0 => array:2 [
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            0 => array:3 [
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              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Criteria for the classification of monoclonal gammopathies&#44; multiple mieloma and related disorders&#58; a report of the International Myeloma Working group"
                      "autores" => array:1 [
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                          "colaboracion" => "International Myeloma Working group"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Haematol"
                        "fecha" => "2003"
                        "volumen" => "121"
                        "paginaInicial" => "749"
                        "paginaFinal" => "757"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12780789"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathogenesis and progression of monoclonal gammopathy of undetermined significance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Blad&#233;"
                            1 => "L&#46; Rosi&#241;ol"
                            2 => "M&#46;T&#46; Cibeira"
                            3 => "C&#46;F&#46; de larrea"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/leu.2008.203"
                      "Revista" => array:6 [
                        "tituloSerie" => "Leukemia"
                        "fecha" => "2008"
                        "volumen" => "22"
                        "paginaInicial" => "1651"
                        "paginaFinal" => "1657"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18668131"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of monoclonal gammopathy of undetermined significance"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;A&#46; Kyle"
                            1 => "T&#46;M&#46; Therneau"
                            2 => "S&#46;V&#46; Rajkumar"
                            3 => "D&#46;R&#46; Larson"
                            4 => "M&#46;F&#46; Plevak"
                            5 => "J&#46;R&#46; Offord"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2006"
                        "volumen" => "354"
                        "paginaInicial" => "1362"
                        "paginaFinal" => "1369"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monoclonal gammopathies of undetermined significance &#40;MGUS&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;A&#46; Kyle"
                            1 => "S&#46;V&#46; Rajkumar"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Best Pract Res Clin Haematol"
                        "fecha" => "2005"
                        "volumen" => "18"
                        "paginaInicial" => "689"
                        "paginaFinal" => "707"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monoclonal gammopathy&#58; the good&#44; the bad and the ugly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;V&#46; Glavey"
                            1 => "N&#46; Leung"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Blood Rev"
                        "fecha" => "2016"
                        "volumen" => "30"
                        "paginaInicial" => "223"
                        "paginaFinal" => "231"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spectrum of manifestations of monoclonal gammopathy-associated renal lesions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Sethi"
                            1 => "F&#46;C&#46; Fervenza"
                            2 => "S&#46;V&#46; Rajkumar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Curr Opin Neprhol Hypertens"
                        "fecha" => "2016"
                        "volumen" => "25"
                        "paginaInicial" => "127"
                        "paginaFinal" => "137"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International Kidney and Monoclonal Gammopathy Research Group&#58; diagnosis of monoclonal gammopathy of renal significance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Bridoux"
                            1 => "N&#46; Leung"
                            2 => "C&#46;A&#46; Hutchinson"
                            3 => "G&#46; touchard"
                            4 => "S&#46; Sethi"
                            5 => "J&#46;P&#46; Fermand"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ki.2014.408"
                      "Revista" => array:7 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2015"
                        "volumen" => "87"
                        "paginaInicial" => "698"
                        "paginaFinal" => "711"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25607108"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735675716303515"
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                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gammapat&#237;as monoclonales de significado renal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Caravaca-Font&#225;n"
                            1 => "E&#46; Guti&#233;rrez"
                            2 => "R&#46; Delgado Lillo"
                            3 => "M&#46; Prag"
                          ]
                        ]
                      ]
                    ]
                  ]
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Article information
ISSN: 20132514
Original language: English
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