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Monoclonal gammopathy of renal significance with no clonal cell line identified 
A 60 year old woman presents with nephrotic syndrome and a kidney biopsy reveals a proliferative GN with monoclonal IgG3 read as monoclonal gammopathy of renal significance (MGRS). Evaluation of the serum and the urine fail to demonstrate a monoclonal gammopathy. A bone marrow biopsy is similarly unremarkable without any clonal population of cells identified. The hematologist therefore fails to acknowledge this as a clonal lymphocyte or plasma cell disorder. The treatment for this MGRS is clonal directed therapy, but what do you do if a clone cannot be identified? This is not an uncommon scenario and nephrologists need to recognize it and educate some of our hematologist colleagues. A treatment algorithm is suggested in this most interesting case

Summary provided by Roger Rodby, MD, FASN.
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