C3 glomerulopathy: a rare kidney histological presentation of multiple myeloma
C3 Glomerulopathy is a rare disease caused by abnormal control of the alternative complement pathway, resulting in a predominant glomerular C3 deposition. Its association with multiple myeloma has been reported in recent literature. We present a case of a 66-year-old women, referred for a nephrology consultation with a stage 4 chronic kidney disease, microhematuria, leukocyturia, sub-nephrotic range proteinuria (1.3 g/24hours), albumin 3.7 g/dl and dyslipidemia. She had been previously studied in a Hematology consultation for a normocytic anemia and an IgG Kappa monoclonal gammopathy, with 16% of plasma cells in bone marrow aspiration, but no hypercalcemia or lytic bone lesions. Autoimmune tests (ANCA, ANA, Anti-dsDNA antibody), C3 and C4 were negative. Eight months later, the patient complained of hypertension and edema, and presented a mild decrease in serum C3 (0.86 g/L [0.90-1.80]) and progressive nephrotic proteinuria (from 4.5 to 6.1 g/24h), with hypoalbuminemia. A kidney biopsy was performed, and we found mild chronic non-specific glomerular and tubule-interstitial findings, on light microscopy, and mesangial C3 deposits (+++), without immunoglobulin deposits, on immunofluorescence. Immunofluorescence with protease-digested paraffin sections was also negative. Genetic study found no complement gene mutation. She was treated with prednisone 1mg/Kg/day, with a favorable clinical and laboratorial response, but whether this treatment is enough it is still being pondered between nephrologists and hematologists
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Sociedade Portuguesa de Nefrologia
2018
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oai:scielo:S0872-016920180001000112018-04-23C3 glomerulopathy: a rare kidney histological presentation of multiple myelomaCosta,Joana SilvaRomãozinho,CatarinaRodrigues,LuísMarinho,CarolSousa,VitorPratas,JorgeCipriano,Maria AugustaAlves,Rui complement C3 glomerulopathy multiple myeloma C3 Glomerulopathy is a rare disease caused by abnormal control of the alternative complement pathway, resulting in a predominant glomerular C3 deposition. Its association with multiple myeloma has been reported in recent literature. We present a case of a 66-year-old women, referred for a nephrology consultation with a stage 4 chronic kidney disease, microhematuria, leukocyturia, sub-nephrotic range proteinuria (1.3 g/24hours), albumin 3.7 g/dl and dyslipidemia. She had been previously studied in a Hematology consultation for a normocytic anemia and an IgG Kappa monoclonal gammopathy, with 16% of plasma cells in bone marrow aspiration, but no hypercalcemia or lytic bone lesions. Autoimmune tests (ANCA, ANA, Anti-dsDNA antibody), C3 and C4 were negative. Eight months later, the patient complained of hypertension and edema, and presented a mild decrease in serum C3 (0.86 g/L [0.90-1.80]) and progressive nephrotic proteinuria (from 4.5 to 6.1 g/24h), with hypoalbuminemia. A kidney biopsy was performed, and we found mild chronic non-specific glomerular and tubule-interstitial findings, on light microscopy, and mesangial C3 deposits (+++), without immunoglobulin deposits, on immunofluorescence. Immunofluorescence with protease-digested paraffin sections was also negative. Genetic study found no complement gene mutation. She was treated with prednisone 1mg/Kg/day, with a favorable clinical and laboratorial response, but whether this treatment is enough it is still being pondered between nephrologists and hematologistsinfo:eu-repo/semantics/openAccessSociedade Portuguesa de NefrologiaPortuguese Journal of Nephrology & Hypertension v.32 n.1 20182018-03-01info:eu-repo/semantics/reporttext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692018000100011en |
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Costa,Joana Silva Romãozinho,Catarina Rodrigues,Luís Marinho,Carol Sousa,Vitor Pratas,Jorge Cipriano,Maria Augusta Alves,Rui |
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Costa,Joana Silva Romãozinho,Catarina Rodrigues,Luís Marinho,Carol Sousa,Vitor Pratas,Jorge Cipriano,Maria Augusta Alves,Rui C3 glomerulopathy: a rare kidney histological presentation of multiple myeloma |
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Costa,Joana Silva Romãozinho,Catarina Rodrigues,Luís Marinho,Carol Sousa,Vitor Pratas,Jorge Cipriano,Maria Augusta Alves,Rui |
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Costa,Joana Silva |
title |
C3 glomerulopathy: a rare kidney histological presentation of multiple myeloma |
title_short |
C3 glomerulopathy: a rare kidney histological presentation of multiple myeloma |
title_full |
C3 glomerulopathy: a rare kidney histological presentation of multiple myeloma |
title_fullStr |
C3 glomerulopathy: a rare kidney histological presentation of multiple myeloma |
title_full_unstemmed |
C3 glomerulopathy: a rare kidney histological presentation of multiple myeloma |
title_sort |
c3 glomerulopathy: a rare kidney histological presentation of multiple myeloma |
description |
C3 Glomerulopathy is a rare disease caused by abnormal control of the alternative complement pathway, resulting in a predominant glomerular C3 deposition. Its association with multiple myeloma has been reported in recent literature. We present a case of a 66-year-old women, referred for a nephrology consultation with a stage 4 chronic kidney disease, microhematuria, leukocyturia, sub-nephrotic range proteinuria (1.3 g/24hours), albumin 3.7 g/dl and dyslipidemia. She had been previously studied in a Hematology consultation for a normocytic anemia and an IgG Kappa monoclonal gammopathy, with 16% of plasma cells in bone marrow aspiration, but no hypercalcemia or lytic bone lesions. Autoimmune tests (ANCA, ANA, Anti-dsDNA antibody), C3 and C4 were negative. Eight months later, the patient complained of hypertension and edema, and presented a mild decrease in serum C3 (0.86 g/L [0.90-1.80]) and progressive nephrotic proteinuria (from 4.5 to 6.1 g/24h), with hypoalbuminemia. A kidney biopsy was performed, and we found mild chronic non-specific glomerular and tubule-interstitial findings, on light microscopy, and mesangial C3 deposits (+++), without immunoglobulin deposits, on immunofluorescence. Immunofluorescence with protease-digested paraffin sections was also negative. Genetic study found no complement gene mutation. She was treated with prednisone 1mg/Kg/day, with a favorable clinical and laboratorial response, but whether this treatment is enough it is still being pondered between nephrologists and hematologists |
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Sociedade Portuguesa de Nefrologia |
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2018 |
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http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692018000100011 |
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