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Korean J Med > Volume 88(3); 2015 > Article
The Korean Journal of Medicine 2015;88(3): 318-323.
당뇨 환자에서 결절성 사구체 경화증으로 경쇄 침착 질환이 진단된 1예
이경호, 강수훈, 이현우, 박가은, 홍연수, 이정은, 김윤구
성균관대학교 의과대학 삼성서울병원 내과
A Case of Light Chain Deposition Disease in a Patient with Diabetes and Nodular Glomerulosclerosis
Kyung Ho Lee, Soo Hoon Kang, Hyun Woo Lee, Ga Eun Park, Yun Soo Hong, Jung Eun Lee, Yoon Goo Kim
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Corresponding Author: Jung Eun Lee ,Tel: +82-2-3410-3449, Fax: +82-2-3410-0064, Email: jungeun34.lee@samsung.com
Received: February 25, 2014;   Revised: March 19, 2014;   Accepted: May 2, 2014.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
A 50 year-old male with a 10-year history of diabetes was admitted to the hospital for edema and foamy urine. At the time of admission, serum creatinine was 1.99 mg/dL and 24 h urine protein levels were 4.0 g/day. Renal biopsy showed nodular glomerulosclerosis. Immunofluorescence demonstrated the presence of kappa light chains along the glomerular and tubular basement membrane. Electron microscopy showed granular electron-dense deposits along the glomerular subendothelium and tubular basement membrane. Serum protein electrophoresis was negative for a monoclonal spike; however, urine protein electrophoresis demonstrated a monoclonal spike. Bone marrow examination was compatible with multiple myeloma and the patient was diagnosed with light-chain deposition disease associated with multiple myeloma. This report stresses the significant challenges that occur when diagnosing light-chain deposition disease in kidneys of patients with long standing diabetes, and discusses previously reported cases of light-chain deposition disease in Korea.
Keywords: Immunoglobulin light chains; Diabetic nephropathies; Multiple myeloma
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