C3 glomerulonephritis in post transplanted patient with MGRS (A case report)

Abstract

C3 glomerulopathy includes several rare forms of glomerulonephritis with underlying defects in the alternative pathway of complement cascade. It is characterized by predominant C3 deposition in glomeruli due to abnormal activation of the alternative pathway of the complement system. C3 GN has been reported to be associated with several systemic diseases. Methods We MEDICUS / No. 4, 2021 13 will describe a case presenting C3 GN in a patient with monoclonal gammopathy of renal significance (MGRS) Results A 61 years old man patient presented with gross hematuria,anemia ,renal disfunction (creatinemia 2,4 mg/dl), proteinuria 814 mg/24 h. The patient was transplanted two years ago and he was taking corticosteroids ,MMF,tacrolimus and entecavir for hepatitis B .Serum protein electrophoresis ; hypogammaglobulinemia with a small homogeneous spike-like peak. Serum Kappa free light chains 32,4 mg/dl ,serum Lambda free light chains 9.3 mg/dl.Ratio 3,4 . Autoimmune tests ANA, ANCA, Anti ds DNA C3 and C4 were negative.Urine Kappa Light Chains 26,4 mg/24 h,urine Lambda Light Chains 6,6 mg/24h.Urine Kappa/Lambda ratio 4. After consultation with haematolgist results of bone narrow biopsy came for monoclonal gammopathy , and FISH conclusion is presence of t(11,14)(q13,q32)which originated from IgH / CCND1 retraction and 1q21 acquisition. Renal biopsy is C3 glomerulopathy with mesengial and diffuse endocapillary proliferation under light microscope and diffuse deposition of C3 and no immunoglobulin under immunofluorescence microscope. Conclusions Monoclonal gammopathy of renal significance MGRS is a term to describe a group of haematological disorders associated with kidney disease that fail to meet the standard definitions for MM or lymphoma. In such cases, the renal impairment is often linked to the underlying hematological disorder. The intention was to make a clear distinction between MGUS, a benign asymptomatic condition, and MGRS, which may be associated with significant morbidity and mortality.