Nodular Glomerulosclerosis Associated With Plasma Cell Neoplasia: A Case Report

Year 2017, Volume: 31 Issue: 2, 117 - 120, 23.08.2017

Serkan Yıldız Evrim Bozkaya Mehtat Ünlü Mehmet Ali Özcan , Ali Çelik Aykut Sifil Caner Çavdar Sülen Sarıoğlu , Taner Çamsarı

Abstract

Nodular glomerulosclerosis is generally identified
as a histopathological diagnosis identical with diabetes mellitus. However, it
can be seen in many diseases like membranoproliferative glomerulonephritis,
monoclonal gammopathy, amyloidosis, fibrillary and immunotactoid glomerulopathy.
Idiopathic nodular glomerulosclerosis can be diagnosed by the exclusion of
these diseases which can be responsible from the etiology.

Medical
history, physical examination, laboratory, immunoserology and histopatologic
examinations are important in differential diagnosis of nodular
glomerulosclerosis. Herein, we present a case of nodular glomerulosclerosis
associated with plasma cell neoplasia.

A
65 year-old woman with swollen legs and feet admitted to our hospital. She had
laboratory examinations showing serum creatinine 3.5 mg/dL, serum albumin 2.9
g/dL and 24 hours urinary protein excretion 11.5. Immunoserological tests were
normal. She had no history of hypertension, her blood pressure was high for a
few months and diabetes mellitus was excluded. Renal biopsy was done and
diagnosed as nodular glomerulosclerosis. A suspicious sharp band was detected
in protein electrophoresis and IgG-Kappa monoclonal gammopathy was observed in
immunfixation. Following bone marrow aspiration and biopsy the patient was diagnosed
as plasma cell disease.

As
a result, if nodular glomerulosclerosis is observed in the renal biopsy of a
non-diabetic patient, other diseases which can be responsible from the etiology
must be investigated. Monoclonal gammopathy should be considered within the
differential diagnosis.

Keywords

Nodular Glomerulosclerosis, Diabetes Mellitus, Plasma Cell Neoplasia

Plazma hücreli neoplazi ile ilişkili nodüler glomerüloskleroz: olgu sunumu

Abstract

Nodüler glomerüloskleroz sıklıkla diyabetes mellitus
ile özdeşleştirilen bir histopatolojik tanıdır. Ancak, membranoproliferatif
glomerülonefrit, monoklonal gammopati, amiloidoz, fibriler ve immünotaktoid
glomerülopati gibi birçok hastalıkta da görülebilir. İdiyopatik nodüler
glomerüloskleroz tanısı ise etyolojiden sorumlu olabilecek tüm bu hastalıkların
dışlanmasıyla konulur.

Nodüler glomerüloskleroz ayırıcı tanısında; öykü,
fizik muayene, laboratuvar, immünoserolojik ve histopatolojik incelemeler
önemlidir. Bu yazıda plazma hücreli neoplazi ile ilişkili nodüler
glomerüloskleroz olgusu sunulmuştur.

65 yaşında kadın hasta ayak ve bacaklarda şişlik
yakınmasıyla hastanemize başvurdu. Laboratuvar tetkiklerinde serum kreatinin 3,5
mg/dL, serum albümin 2,29 g/dL ve 24 saatlik idrarda protein atılımı 11,5 gram
saptandı. İmmünoserolojik testler olağandı. Hipertansiyon  öyküsü olmayan, son birkaç aydır kan basıncı
yüksekliği olan hastada diyabetes mellitus tanısı dışlandı. Böbrek biyopsisi
ile nodüler glomerüloskleroz tanısı konuldu. Serum protein elektroforezinde gamma
bölgesinde şüpheli keskin bant ve immünfiksasyonda IgG-Kappa monoklonal
gammopati gözlendi. Hastaya kemik iliği aspirasyonu ve biyopsisi yapıldı.
Plazma hücreli neoplazi tanısı konuldu.

Sonuç olarak, diyabetik olmayan bir hastanın böbrek
biyopsisinde nodüler glomerüloskleroz saptanırsa diğer olası nedenler
araştırılmalıdır. Ayırıcı tanıda, monoklonal gammopati de mutlaka
düşünülmelidir.

Keywords

Nodüler Glomerüloskleroz, Diyabetes Mellitus, Plazma Hücreli Neoplazi

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