Serkan YILDIZ, Evrim BOZKAYA, ŞADİYE MEHTAT ÜNLÜ, MEHMET ALİ ÖZCAN, CANER ÇAVDAR, Aykut SİFİL, ALİ ÇELİK, SÜLEN SARIOĞLU, TANER ÇAMSARI

Monoklonal Gammopati ile birliktelik gösteren glomerülonefritler: iki olgu

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

Glomerulonephritis Associated With Monoclonal Gammopathy: Two Cases

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.

Keywords:

Monoclonal Gammopathy, C3 Glomerulonephritis, Membranoproliferative Glomerulonephritis,

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