As so defined, light chain MGUS comprises ~19% of all MGUS cases, occurs in ~0.8% of the general population, and progresses to light chain multiple myeloma at the very slow rate of 0.3 cases per 100 years.Some early studies have reported that a very rapid rate of progression occurs in light chain MGUS patients who have free light chain κ/λ or λ/κ ratios equal to or greater than 100 (i.e. and κ/λ ratio outside of 0.02 to 100). About 80% of individuals bearing these light chain ratios were found to progress to light chain multiple myeloma within 2 years. In consequence, these individuals were recommended for being diagnosed and treated as having light chain multiple myeloma. However, two more recent studies reported a 2-year progression rate for these patients of 64% and 30%. It is therefore suggested that the diagnosis of light chain multiple myeloma based solely on a free κ/λ light chain ratio of 0.02 to 100 may be premature. Monoclonal gammopathy of renal significance
Monoclonal gammopathy of renal significance or MGRS designates any MGUS disorder that has a clinically significant impact on renal function. MGRS can be caused by the deposition of a monoclonal immunoglobulin in, and consequent injury to, the kidneys. The diagnosis of this form of MGRS is made based on the presence of: 1) a disorder meeting the criteria for MGUS; b) decreased kidney function as evidence by, e.g.
Management
If the patient has a known allergen or trigger for the eosinophilic bronchitis, the recommended treatment is to avoid the triggers. If the cause of the eosinophilic bronchitis is unknown, the first line treatment is inhaled corticosteroids. Patients respond well to inhaled corticosteroids and their eosinophil counts in their sputum usually decrease after treatment.There has not been a study to determine the ideal dosage of inhaled corticosteroids for patients with eosinophilic bronchitis, and there is no consensus on whether the treatment should be discontinued once the patients symptoms resolve or to continue long-term. The use of oral corticosteroids for eosinophilic bronchitis is rare, but it may be considered when inhaled corticosteroids are ineffective in managing the symptoms. Epidemiology
Approximately 10–30% of people who present with a chronic cough are suspected to be symptomatic due to eosinophilic bronchitis. == References ==