17 June 2023
: Case report 
A 78-Year-Old Man with Chronic Kidney Disease and Monoclonal Gammopathy Who Developed Post-Transplant C3 Glomerulopathy – Recurrence or De Novo? A Case Report and Literature Review
Challenging differential diagnosis, Rare coexistence of disease or pathology
María Carmen Ruiz-Fuentes
1ABEF*, Mercedes Caba-Molina 2D, Aurora Polo-Moyano1B, Magdalena Palomares-Bayo1B, Pilar Galindo-Sacristan1B, Carmen De Gracia-Guindo 1E
DOI: 10.12659/AJCR.939726
Am J Case Rep 2023; 24:e939726
Table 1. Complementary tests.
| – Blood clotting test: normal |
| – Proteinuria 0.6–1 gr/24 h |
| – Haptoglobin: normal. Peripheral blood smear without schistocytes |
| – HBV, HCV, HIV serology: negative |
| – CMV DNA quantification: negative |
| – BK viremia: negative |
| – Reactive C protein and procalcitonin: normal |
| – Chest radiograph: normal |
| – Urine culture: negative (after levofloxacin treatment) |
| – C3: 46.5 mg/dl (90–180) |
| – C4: 12 mg/dl (10–40) |
| – Immunoglobulins: normal |
| – Serum lambda and kappa chains: normal |
| – Monoclonal peak IgG-lambda 0.05 gr/dl |
| – ANCA: negative |
| – Anti-MBG antibodies: negative |
| – ENA: negative |
| – ANA 1/160 |
| – Anti-DNA antibodies: negative |
| – HLA I: negative |
| – MICA: negative |
| – DQ A105: 03 and 05: low-intensity (low and stable MFI) and pre-existing |
| – Mild increase of cortical echogenicity but a good corticomedullar differentiation |
| – Loss of pre-existing pyelocaliceal dilation, with a minimum pelvic ectasia of 9 mm without ureteral dilation |
| – Accumulation of peri-renal fluid, lower to the kidney of 3.8×2.8 cm |
| – Correct kidney vascularization, IR (0.66–0.71) |
| – Permeable iliac vessels. PSV in arterial anastomosis 165 cm/s |
| HBV – hepatitis B virus; HCV – hepatitis C virus; HIV – human immunodeficiency virus; CMV – cytomegalovirus; ANCA – antineutrophil cytoplasmic antibodies; anti-BGM – antiglomerular basement membrane; ENA – extractable nuclear antigen antibodies; ANA – antinuclear antibodies; MICA – major histocompatibility complex class I chain-related molecule A; IR – resistive index. |