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İdiyopatik Membranöz Nefropatinin Ender Bir Komplikasyonu: Kresentik Transformasyon

Rare Complication of Idiopathic Membranous Nephropathy: Cresentic Transformation

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2008

Key Words:

Keywords (Original Language):

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Abstract (2. Language): 
In this study, the cause of rapidly deteriorating renal functions in a follow-up period of a 65-year-old female patient, who applied with nephrotic syndrome findings and diagnosed as membranous nephropathy, is presented. A 65-year-old patient with findings of nephrotic syndromes had normal sizes of kidneys, normal serum complement level, and negative autoantibodies and viral serology. In histopathologic examination, 20 glomeruli was consistent with membranous glomerulonephritis. The patient evaluated as idiopathic membra¬nous nephropathy was montly followed-up with supportive treat¬ment. In the second month of follow-up, re-evaluation of the patient due to nausea and urine discoloration revealed 144 mg/dL urea, 6.3 mg/dL creatinin, 2.5 g/dl albumin. Urine sediment revealed dismorphic erytrocytes and granular silenders. Renal re-biopsy was done. Of 11 glomeruli, 3 global sclerosis, 8 cresentic glomeruli with fibrosis and scarce cellular component were seen. The case was accepted as cresentic glomerulonephritis, a rare complication of idiopathic MN. Before the treatment, anti-GBM, pANCA, cANCA, ANA were negative. Pulse metil prednizolon and pulse endoksan treatment protocol was administered. Hemodialysis was needed 9 times. At the end of the first month of the treatment, hemodialysis was no longer needed. Due to chance of spontaneous remission up to 30% of membranous nephropathy, there is no consensus on specific treatment applicable to all cases. However, cresentic GN should be investi¬gated immediately when sudden and rapid deterioration of renal functions appeared.
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Abstract (Original Language): 
Burada nefrotik sendrom bulgularıyla müracaat eden ve mem-branöz nefropati (MN) olduğu saptanan 65 yaşındaki bir kadın hastanın izlem sırasında böbrek fonksiyonlarında gözlenen hızlı bozulmanın nedeni sunulmuştur. Nefrotik sendrom bulguları saptanan 65 yaşındaki kadın hastanın böbrek boyutları ve kompleman düzeyleri normal, otoantikorla-rı ve viral serolojisi negatifti. Yirmi glomerülün gözlemlendiği biyopsi bulguları membranöz glomerülonefrit ile uyumluydu. idiyo-patik MN olarak kabul edilen hasta destek tedaviyle izlenmeye alın¬dı. ikinci ayda bulantı, idrar renginde koyulaşma yakınmalarıyla yapılan değerlendirmede üre 144 mg/dL, kreatinin 6.3 mg/dL, albü-min 2.5 g/dl saptandı. idrar sedimentinde bol miktarda dismorfik eritrosit ve granüler silendir gözlendi ve biyopsi tekrarına karar ve¬rildi. Gözlenen 11 glomerülün üçünde global skleroz, sekizinde se-lüler komponenti bulunan yer yer fibrotik kresent saptandı. Olgu idiyopatik MN'nin ender bir komplikasyonu olan kresentrik glomerülonefrit olarak kabul edildi. Tedavi öncesi anti-GBM antikoru, pANCA, cANCA, ANA negatifti. Pulse metil prednizolon ve pulse endoksan tedavi protokolüne alındı. Dokuz seans hemodiyaliz gereksinimi oluştu. Tedavinin 1. ayı sonunda hemodiyaliz ihtiyacı ortadan kalktı. Membranöz nefropatide %30 oranında spontan remisyon ola¬sılığı nedeniyle her olguya spesifik tedavi uygulanması konusunda görüş birliği yoktur. Ancak ani ve hızlı fonksiyon bozukluklarında kresentik glomerülonefrit varlığı vakit kaybedilmeksizin yeni bir biyopsi ile araştırılmalıdır.
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  • 2
77-80
  • Turkish

REFERENCES

References: 

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Official Journal of the Turkish Society of Nephrology / Türk Nefroloji Diyaliz ve Transplantasyon Dergisi
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