Glomerulonephritis Associated With Monoclonal Gammopathy: Two Cases

Yıl 2017, Cilt: 31 Sayı: 3, 171 - 175, 15.12.2017

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

Öz

Plasma cell diseases or
monoclonal gammopathies are group of disorders which occur as a result of
uncontrolled proliferation of plasma cells and over production of
immunglobulins. One of the important problems encountered in plasma cell
disorders is renal diseases. Herein, we present two different cases of glomerulonephritis
which are associated with monoclonal gammopathy.study. Both the scale and the
data collection sheet was applied to the students in classess or in a study
environment. 

First case was a 51 year-old-man with
anemia, acute renal failure (ARF) and isolated microscopic hematuria whom were referred
to nephrology outpatient clinic. He had no history of hypertension (HT),
diabetes mellitus (DM), renal disease and nephrotoxic drug usage. Renal biopsy
was done and diagnosed as C3 glomerulonephritis (C3GN).

Second case was a 69 year-old-man whom had
a history of chronic renal failure (CRF), HT, DM and chronic ischemic heart
disease. He had a progressively increased proteinuria for a one year during the
nephrology outpatient clinic follow-up. He had nephrotic proteinuria and no
hematuria. Atypical proteinuria was considered. Renal biopsy was done and
diagnosed as membranoproliferative glomerulonephritis (MPGN).

Both of the cases were investigated for
monoclonal gammopathy during the inpatient clinic follow-up. A sharp band was
detected in protein electrophoresis and IgG-Kappa monoclonal gammopathy was
observed in immunfixation in both of the cases. Bone marrow aspiration and
biopsy were done and diagnosed as multiple myeloma.

The circulating paraproteins cause a
diversity of kidney diseases and they can affect the glomeruli especially. If
patient is diagnosed as MPGN or C3GN, secondary reasons including the
monoclonal gammopathies must be absolutely investigated.

Anahtar Kelimeler

Monoclonal Gammopathy, C3 Glomerulonephritis, Membranoproliferative Glomerulonephritis

Monoklonal Gammopati ile birliktelik gösteren glomerülonefritler: iki olgu

Öz

Plazma hücresi hastalıkları veya
monoklonal gammopatiler; plazma hücrelerinin kontrolsüz çoğalması nedeniyle
immünglobulinlerin aşırı üretilmesi sonucu meydana gelen bir grup hastalıktır.
Plazma hücresi hastalıklarında karşılaşılan en önemli problemlerden birisi de
böbrek hastalıklarıdır. Bu yazıda monoklonal gammopati ile birliktelik gösteren
farklı iki glomerülonefrit olgusu sunulmuştur.

İlk olgumuz 51 yaşında ve erkekti.
Anemi, akut böbrek yetmezliği (ABY) ve izole mikroskopik hematüri nedeniyle
nefroloji polikliniğine sevk edildi. Hipertansiyon (HT), diyabetes mellitus
(DM), böbrek hastalığı ve nefrotoksik ilaç kullanımı öyküsü yoktu. Böbrek
biyopsisi yapıldı ve C3 glomerülonefriti (C3GN) tanısı konuldu.

İkinci olgumuz 69 yaşında ve erkekti.
Kronik böbrek yetmezliği (KBY), HT, DM ve kronik iskemik kalp hastalığı öyküsü
vardı. Nefroloji poliklinik izleminde son bir yılda proteinüride dikkat çekici
bir artış gözlendi. Nefrotik düzeyde proteinürisi vardı, hematürisi yoktu.
Atipik proteinüri düşünüldü, böbrek biyopsisi yapıldı ve membranoproliferatif
glomerülonefrit (MPGN) tanısı konuldu.

Her iki olguda klinik izlemi sırasında Monoklonal
Gammopati açısından araştırıldı. Her iki olguda da; serum protein
elektroforezinde gamma bölgesinde keskin bant ve immünfiksasyonda IgG-Kappa
monoklonal gammopati saptandı. Kemik iliği aspirasyonu ve biyopsisi yapıldı,
multipl miyelom tanısı konuldu.

Dolaşımdaki paraproteinler çeşitli böbrek hastalıklarına neden olurlar
ve özellikle glomerülleri etkileyebilirler. Histopatolojik olarak MPGN ve C3GN
tanısı konulduğunda monoklonal gammopatilerin de arasında olduğu ikincil
nedenler mutlaka araştırılmalıdır.

Anahtar Kelimeler

Monoklonal Gammopati, C3 Glomerülonefriti, Membranoproliferatif Glomerülonefrit

Kaynakça

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