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Membranoproliferatif glomerulonefrit (MPGN) immün komplekslerin subendotelyal ve mezanjial birikimi ile karakterize bir immün kompleks aracılı glomerulonefrittir. Membranoproliferatif glomerulonefrit 'in daha az bilinen nedenleri arasında monoklonal gamopatiler yer almaktadır. Bu yazıda multiple myeloma sekonder membranoproliferatif glomerülonefrit (MPGN) zemininde son dönem böbrek yetmezliği gelişen bir olgu sunulmuştur. Olgumuz 51 yaşında ve erkekti. 1 aydır devam eden hipertansiyon, baş ağrısı, ayaklarda şişlik ve halsizlik şikayetleri ile kliniğimize başvurdu. Hastanın bilinen bir ek hastalığı ve düzenli tansiyon takibi yoktu. Tetkiklerinde böbrek boyutları normal olan, dikkat çekici hematürisi mevcut olan hastada kronik böbrek yetmezliği etyolojisinin aydınlatılması için böbrek biyopsisi yapıldı ve membranoproliferatif glomerülonefrit (MPGN) tanısı konuldu. Olgu klinik izlemi sırasında monoklonal gammopati açısından araştırıldı. Gönderilen idrar immünfiksasyon elektroforezde serbest kappa hafif zincir proteini saptandı. Kemik iliği aspirasyonu ve biyopsisi yapıldı, multipl miyelom tanısı konuldu. Nedeni bilinmeyen kronik böbrek yetmezlikli hastalarda altta yatan sebepleri aydınlatmaya yönelik böbrek biyopsisi ve ileri incelemeler yapılmalı ve histopatolojik olarak membranoproliferatif glomerülonefrit tanısı konulduğunda monoklonal gammopatilerin de arasında olduğu ikincil nedenler mutlaka araştırılmalıdır.
Membranoproliferative glomerulonephritis is an immune complex characterized by the deposite of subendothelial and mesangial. Monoclonal gammopathies are among the few known reasons for membranoproliferative glomerulonephritis. In this case, multiple myeloma is presented as a secondary cause of membranoproliferative glomerulonephritis leading to end stage renal failure. Our patient is 50 year-old man presenting with hypertension, headache, weakness and pretibial edema for one month. The patient has no known additional disease and no hypertension follow up. To explain the cause of end stage renal failure in the patient with normal renal sizes and marked hematuria, renal biopsy was made and membranoproliferative glomerulonephritis was diagnosed. During the follow up, monoclonal gammopathy was researched. In the urine immunofixation electrophoresis analysis, free cappa light chain protein was found and multiple myeloma was diagnosed by bone marrow aspiration biopsy. To explain the underlying etiology in patients with unknown origin of chronic renal failure, renal biopsy and further examinations should be performed and when membranoproliferative glomerulonephritis is diagnosed histopathologically, monoclonal gammopathies have to be consiedered as a secondary cause.
Membranoproliferative glomerulonephritis is an immune complex characterised by deposite of subendothelial and mesangial. Monoclonal gammopathies are among the few known reasons for membranoproliferative glomerulonephritis. In this case, multiple myeloma is presented as secondary cause of membranoproliferative glomerulonephritis leading to end stage renal failure. Our patient is 50 year-old man presenting with hypertension, headache, weakness and pretibial edema for one month. The patient has no known addditional disease and no hypertension follow up. To explain the cause of end stage renal failure in the patient with normal renal sizes and marked hematuria, renal biopsy was made and membranoproliferative glomerulonephritis was diagnosed. During the follow up, monoclonal gammopathy was researched. In the urine immunofixation electrophoresis analysis, free kappa light chain protein was found and multiple myeloma was diagnosed by bone marrow aspiration biopsy. To explain the underlying etiology in patients with unknown origin of chronic renal failure, renal biopsy and further examinations should be performed and when membranoproliferative glomerulonephritis is diagnosed histopathologically, monoclonal gammopathies have to be consiedered as a secondary cause.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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