There is a predominance of clonal plasma cells in the bone marrow with an abnormal immunophenotype (CD38+ CD56+ CD19−) mixed in with cells of a normal phenotype (CD38+ CD56− CD19+); in MGUS, on average more than 3% of the clonal plasma cells have the normal phenotype, whereas in multiple myeloma, less than 3% of the cells have the normal phenotype. Diagnosis
MGUS is a common, age-related medical condition characterized by an accumulation of bone marrow plasma cells derived from a single abnormal clone. Patients may be diagnosed with MGUS if they fulfill the following four criteria:
A monoclonal paraprotein band less than 30 g/L (< 3g/dL);
Plasma cells less than 10% on bone marrow examination;
No evidence of bone lesions, anemia, hypercalcemia, or chronic kidney disease related to the paraprotein, and
No evidence of another B-cell proliferative disorder. Differential diagnosis
Several other illnesses can present with a monoclonal gammopathy, and the monoclonal protein may be the first discovery before a formal diagnosis is made:

Multiple myeloma
Smouldering multiple myeloma
AIDS
Chronic lymphocytic leukemia
Non-Hodgkin lymphoma, particularly Splenic marginal zone lymphoma and Lymphoplasmocytic lymphoma
Hepatitis C
Connective tissue disease such as lupus
Immunosuppression following organ transplantation
Waldenström macroglobulinemia
Guillain–Barré syndrome
Tempi syndrome
POEMS

Management
The protein electrophoresis test should be repeated annually, and if there is any concern for a rise in the level of monoclonal protein, then prompt referral to a hematologist is required.
Lisinopril/hydrochlorothiazide, sold under the brand name Zestoretic among others, is a fixed-dose combination medication used for the treatment of high blood pressure. It contains lisinopril, an ACE inhibitor, and hydrochlorothiazide, a diuretic. Typically, it becomes an option once a person is doing well on the individual components. It is taken by mouth.Common side effects include dizziness, headache, cough, and feeling tired. Severe side effects may include angioedema and low blood pressure. Use during pregnancy may harm the baby.The combination was approved for medical use in the United States in 1989. It is on the World Health Organizations List of Essential Medicines. It is available as a generic medication. In 2020, it was the 50th most commonly prescribed medication in the United States, with more than 13 million prescriptions. References
External links
"Hydrochlorothiazide mixture with lisinopril". Drug Information Portal. U.S. National Library of Medicine.