Kim Jin Hae, Kim Ji Won, Kim Young Nam, Kim Hye In, Kim Jun Young, Kwon Ghee Young, Kim Kihyun, Jang Hye Ryoun
Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Case Rep Nephrol Dial. 2015 Sep 2;5(3):180-6. doi: 10.1159/000439267. eCollection 2015 Sep-Dec.
Monoclonal gammopathy with undetermined significance (MGUS) carries a risk of progression to multiple myeloma, and progression is usually diagnosed with changes in M-protein or bone marrow biopsy. We report a case of 62-year-old female patient showing MGUS progression to multiple myeloma without significant changes in M-protein but diagnosed by kidney biopsy. During the follow-ups, azotemia and tubular proteinuria were aggravated without elevation of M-protein. Kidney biopsy showed intratubular and glomerular inclusions associated with plasma cell dysplasia. The progression of MGUS to multiple myeloma was diagnosed by this kidney biopsy. The patient's renal function and tubular proteinuria were markedly improved after chemotherapy.
意义未明的单克隆丙种球蛋白病（MGUS）有进展为多发性骨髓瘤的风险，通常通过M蛋白变化或骨髓活检来诊断进展情况。我们报告一例62岁女性患者，其MGUS进展为多发性骨髓瘤，M蛋白无显著变化，但通过肾脏活检确诊。在随访期间，氮质血症和肾小管蛋白尿加重，而M蛋白未升高。肾脏活检显示肾小管和肾小球内有与浆细胞发育异常相关的包涵体。通过此次肾脏活检诊断出MGUS进展为多发性骨髓瘤。化疗后患者的肾功能和肾小管蛋白尿明显改善。
