melphalan and Glomerulonephritis

There is currently no standard treatment for monoclonal immunoglobulin (MIg)-associated C3 glomerulopathy, and treatment is often dictated by the extent of the monoclonal gammopathy. Although chemotherapy treatment for MIg-associated C3 glomerulopathy may stabilize renal function, the overall renal prognosis of MIg-associated C3 glomerulopathy is still poor with frequent progression to end-stage renal disease. We present a case of a 55-year-old man with IgG-κ gammopathy-associated C3 glomerulonephritis (C3GN) with bone marrow biopsy demonstrating 5 - 10 κ-restricted plasma cells. Following chemotherapy treatment unfortunately, the patient encountered relapsing courses of the disease. The patient subsequently received high-dose melphalan treatment followed by autologous hematopoietic stem cell transplant (ASCT). At 8 months follow-up, the patient remained hematologic response with stable kidney function. Since ASCT can offer durable hematologic remission, ASCT can potentially be a curative treatment option for patients with MIg-associated C3GN.
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Topics: Biopsy, Needle; Complement C3; Glomerulonephritis; Hematopoietic Stem Cell Transplantation; Humans; Kidney Glomerulus; Male; Melphalan; Middle Aged; Paraproteinemias; Prognosis; Transplantation, Autologous

Topics: Antineoplastic Combined Chemotherapy Protocols; Biopsy; Combined Modality Therapy; Cyclophosphamide; Dexamethasone; Doxorubicin; Glomerular Mesangium; Glomerulonephritis; Humans; Immunoglobulin kappa-Chains; Magnetic Resonance Imaging; Male; Melphalan; Middle Aged; Multiple Myeloma; Myeloma Proteins; Peripheral Blood Stem Cell Transplantation; Proteinuria; Remission Induction; Transplantation, Autologous; Vincristine

Topics: Anti-Inflammatory Agents; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Boronic Acids; Bortezomib; Carcinoma, Squamous Cell; Clarithromycin; Dexamethasone; Diphosphonates; Glomerulonephritis; Humans; Idarubicin; Imidazoles; Immunosuppressive Agents; Male; Melphalan; Middle Aged; Multiple Myeloma; Nephrotic Syndrome; Pamidronate; Protein Synthesis Inhibitors; Pyrazines; Skin Neoplasms; Thalidomide; Zoledronic Acid

A 68-year-old man with a 30-year history of essential thrombocytosis developed nephrotic syndrome. Renal biopsy showed massive deposits of Congo red-negative periodic acid Schiff (PAS)-positive substance in the mesangium and capillary wall that was positive for IgG. Electron microscopic examination revealed 10- to 20-nm fibrils in the deposits, and there was no other organ involvement; thus, we diagnosed fibrillary glomerulonephritis. This is the first report of a case of fibrillary glomerulonephritis associated with essential thrombocytosis.

Topics: Aged; Anti-Inflammatory Agents; Antineoplastic Agents, Alkylating; Bone Marrow; Glomerulonephritis; Humans; Kidney; Male; Melphalan; Microscopy, Electron; Nephrotic Syndrome; Prednisolone; Thrombocytosis