C3 glomerulonephritis associated with monoclonal gammopathy of renal significance: case report.

BACKGROUND: Morbidity associated with monoclonal gammopathy of renal significance is high due to the severe renal lesions and the associated systemic alterations. Accordingly, early diagnosis is fundamental, as is stopping the clonal production of immunoglobulins using specific chemotherapy. CASE PRESENTATION: A 75-year-old man with chronic renal disease of unknown origin since 2010 experienced rapid worsening of renal function over a period of 6 mos. Bone marrow biopsy showed monoclonal gammopathy of undetermined significance. Kidney biopsy showed the presence of C3 glomerulonephritis, with exclusive deposits of C3 visible on immunofluorescence and a membranoproliferative pattern on light microscopy. Skin biopsy showed endothelial deposition of complement. Given both the renal and cutaneous involvement the patient was considered to have monoclonal gammopathy of renal significance. We considered an underlying pathogenic mechanism for the renal alteration secondary to activation of the alternative complement pathway by the anomalous immunoglobulin. Despite treatment with plasmapheresis, bortezomib and steroids, advanced chronic kidney disease developed. CONCLUSIONS: The possible underlying cause of the monoclonal gammopathy of renal significance suggests that monoclonal gammopathy should be considered in adult patients with membranoproliferative glomerulonephritis.

Papel de la denervación simpática de arterias renales en un paciente con hipertensión arterial refractaria / Role of renal sympathetic denervation in a refractory arterial hypertension patient

A pesar de los progresos en el tratamiento farmacológico de la hipertensión arterial (HTA) y el empleo de múltiples fármacos antihipertensivos, un pequeño pero significativo porcentaje de los pacientes con HTA refractaria severa verdadera continúa sin alcanzar su objetivo de control tensional. En estos casos, la denervación simpática renal (DNSR) parece mostrarse como un método seguro y eficaz para aquellos pacientes hipertensos severos refractarios al tratamiento farmacológico múltiple. Presentamos el caso de un paciente de 52 años de edad diagnosticado de HTA esencial refractaria a tratamiento con 7 fármacos antihipertensivos. Tras 10 ingresos hospitalarios sin conseguir un adecuado control de las cifras de presión arterial, decidimos plantear la DNSR como coadyuvante al tratamiento médico. El procedimiento se realizó sin complicaciones a corto y medio plazo, consiguiéndose una mejoría significativa de las cifras tensionales, con el objetivo de disminuir su riesgo vascular global (AU)

Despite advances in the pharmacological treatment of arterial hypertension (AHT) and the use of multiple antihypertensive drugs, a small but significant percentage of true severe refractory arterial hypertension patients are still not reaching their target blood pressure. In these cases, renal sympathetic denervation (RSD) seems to be a safe and effective method for severe hypertensive patients who are resistant to multiple drug treatment. We present the case of a 52-year-old patient diagnosed with essential hypertension, resistant to treatment with seven antihypertensive drugs. After 10 hospitalisations without achieving adequate blood pressure control, we decided to propose renal sympathetic denervation as an addition to medical treatment. The procedure was performed without complications in the short to medium-long term, achieving a significant improvement in blood pressure with the intention of reducing overall vascular risk (AU)

Role of renal sympathetic denervation in a refractory arterial hypertension patient.

Despite advances in the pharmacological treatment of arterial hypertension (AHT) and the use of multiple antihypertensive drugs, a small but significant percentage of true severe refractory arterial hypertension patients are still not reaching their target blood pressure. In these cases, renal sympathetic denervation (RSD) seems to be a safe and effective method for severe hypertensive patients who are resistant to multiple drug treatment. We present the case of a 52-year-old patient diagnosed with essential hypertension, resistant to treatment with seven antihypertensive drugs. After 10 hospitalisations without achieving adequate blood pressure control, we decided to propose renal sympathetic denervation as an addition to medical treatment. The procedure was performed without complications in the short to medium-long term, achieving a significant improvement in blood pressure with the intention of reducing overall vascular risk.