A 58-yr-old man presented with leg edema and subacute weakness of his bilateral lower extremities. Urinary and serum immunoelectrophoresis revealed the presence of lambda-type Bence Jones proteins. He was ultimately diagnosed with monoclonal gammopathy of undetermined significance (MGUS). A renal biopsy specimen showed fibrillary glomerulonephritis (FGN), which was randomly arranged as 12–20 m nonbranching fibrils in the basement membranes. Immunofluorescence studies were negative for immunoglobulin (Ig)G, IgM, IgA, C3, and kappa light chains in the capillary walls and mesangial areas. A Congo red stain for amyloid was negative. Electromyography and nerve conduction velocity examinations results were compatible with the presence of demyelinating polyneuropathy. This case showed a rare combination of FGN, without Ig deposition, and MGUS combined with chronic inflammatory demyelinating polyneuropathy (CIDP).
Renal cell carcinoma (RCC) is the second most common urological malignancy and it has diverse range of clinical manifestation. One third of the patients show the metastasis at the time of the diagnosis. The common sites of metastasis are the lung, bone, lymph nodes and metastasis to the pancreas is rare. In case of pancreatic metastasis, more than half of the patients are asymptomatic. Patients with symptoms visit hospital complaining of abdominal pain, weight loss, steatorrhea and rarely biliary obstruction. Although about 40% of all patients visit hospital with hemorrhage, cholangitis caused by spontaneous pancreatic hemorrhage is rare. We report an interesting case of 61-year-old woman with cholangitis caused by bleeding due to pancreatic metastasis from renal cell carcinoma.
Nephrotic syndrome is characterized by hypercoagulability and thrombosis of the renal and deep veins. We describe a case of unusual thrombosis in the portal and superior mesenteric veins of a 41-year-old female, admitted for treatment of abdominal pain, who simultaneously presented with nephrotic syndrome and acute pancreatitis. Laboratory analysis revealed hypoalbuminemia, hyperlipidemia, and proteinuria. Abdominal computed tomography revealed acute pancreatitis, thrombosis at the portal and superior mesenteric veins, and ischemic changes in the colon and small intestines. Anticoagulation therapy was started immediately. Abdominal pain was subsequently reduced and the ischemic lesion disappeared. Warfarin use could not be terminated immediately. Empirical steroid therapy commenced without a kidney biopsy. Complete remission occurred after 4 weeks. Following warfarin cessation, a kidney biopsy was performed, confirming the diagnosis of minimal change disease. (Korean J Med 2015;88:212-217) Keywords: Nephrotic syndrome; Pancreatitis 서 론 신증후군은 과응고성 상태로 인해 신정맥, 폐동맥 등의 주 요 혈관에 혈전증을 유발할 수 있는 질환으로 동맥과 정맥 모두에서 발생할 수 있으나 정맥에서 발생 빈도가 더 높다 고 알려져 있다[1]. 과응고 경향은 혈액 응고 기전과 섬유소 분해 기전, 혈소판 기능 변화 등으로 인해 나타날 수 있다[2]. 신증후군 환자에서 간문맥과 상대정맥에 혈전증이 발생한 경우는 매우 드문 것으로 보고되고 있다. 급성 췌장염은 염증성 질환으로 흔히 급성 복통, 오심, 구 토, 소화장애 등을 유발하는 질환이다. 발생 원인으로는 담 석, 술이 가장 흔하다. 고중성지방 혈증 또한 급성 췌장염을 유발할 수 있다[3]. 고중성지방 혈증의 원인은 원발성과 이 차성으로 나눌 수 있는데 원발성 고중성지방 혈증은 유전적
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