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      Resolution of Nodular Glomerular Lesions in a Patient with Light-Chain Nephropathy

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      Nephron

      S. Karger AG

      Light-chain nephropathy, Nodular lesion, Resolution, Steroid pulse, Melphalane

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          Abstract

          A 37-year-old man developed nephrotic syndrome and renal insufficiency in 1986. He had ĸ-light-chain protein both in serum and urine. A renal biopsy showed nodular glomerulosclerosis with deposition of ĸ-light-chains in the mesangial area, compatible with light-chain nephropathy. Thereafter, he was treated with steroids and melphalane and the light-chain protein disappeared from both the urine and serum. Although his moderately impaired renal function maintained stable levels for over 10 years, he was diagnosed as having renal cell carcinoma in 1998, and a right nephrectomy was performed. Histopathological examination of a portion of the removed kidney, unaffected by carcinoma, showed mild mesangial proliferation, and both the nodular lesions and light-chain deposits were no longer observed. These observations suggest that an established nodular glomerular lesion may be reversible.

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          Reversal of lesions of diabetic nephropathy after pancreas transplantation.

          In patients with type I diabetes mellitus who do not have uremia and have not received a kidney transplant, pancreas transplantation does not ameliorate established lesions of diabetic nephropathy within five years after transplantation, but the effects of longer periods of normoglycemia are unknown. We studied kidney function and performed renal biopsies before pancreas transplantation and 5 and 10 years thereafter in eight patients with type I diabetes but without uremia who had mild to advanced lesions of diabetic nephropathy at the time of transplantation. The biopsy samples were analyzed morphometrically. All patients had persistently normal glycosylated hemoglobin values after transplantation. The median urinary albumin excretion rate was 103 mg per day before transplantation, 30 mg per day 5 years after transplantation, and 20 mg per day 10 years after transplantation (P=0.07 for the comparison of values at base line and at 5 years; P=0.11 for the comparison between base line and 10 years). The mean (+/-SD) creatinine clearance rate declined from 108+/-20 ml per minute per 1.73 m2 of body-surface area at base line to 74+/-16 ml per minute per 1.73 m2 at 5 years (P<0.001) and 74+/-14 ml per minute per 1.73 m2 at 10 years (P<0.001). The thickness of the glomerular and tubular basement membranes was similar at 5 years (570+/-64 and 928+/-173 nm, respectively) and at base line (594+/-81 and 911+/-133 nm, respectively) but had decreased by 10 years (to 404+/-38 and 690+/-111 nm, respectively; P<0.001 and P=0.004 for the comparisons with the base-line values). The mesangial fractional volume (the proportion of the glomerulus occupied by the mesangium) increased from base line (0.33+/-0.07) to 5 years (0.39+/-0.10, P=0.02) but had decreased at 10 years (0.27+/-0.02, P=0.05 for the comparison with the baseline value and P=0.006 for the comparison with the value at 5 years), mostly because of a reduction in mesangial matrix. Pancreas transplantation can reverse the lesions of diabetic nephropathy, but reversal requires more than five years of normoglycemia.
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            Author and article information

            Journal
            NEF
            Nephron
            10.1159/issn.1660-8151
            Nephron
            S. Karger AG
            1660-8151
            2235-3186
            2002
            July 2002
            01 July 2002
            : 91
            : 3
            : 504-505
            Affiliations
            Department of Nephrology, Sendai Shakaihoken Hospital, Sendai, Japan
            Article
            64296 Nephron 2002;91:504–505
            10.1159/000064296
            12119486
            © 2002 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Figures: 1, References: 4, Pages: 2
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/64296
            Categories
            Short Communication

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