Rare Cause of IgM Nephropathy: Adult Still’s Disease

The type of mesengial proliferative glomerulonephritis having IgM deposition in DIF examination is called IgM nephropathy. A case performed renal biopsy due to urine findings and diagnosed as IgM nephropathy is presented. The patient was hospitalized for a 3-week fever of 39°C and weight loss. Viral and bacterial causes were not positive, and ANA, anti-ANA and ANCA were negative. Owing to persistent hematuri and 1050 mg/day proteinuria, biopsy was done. In the period of hospitalization, arthritis was observed, microscopic examination of arthrosentesis revealed inflammmatory arthritis. Complement levels were normal. Renal biopsy revealed increased mesengial matrix, cellular proliferation, and mesengial IgM deposition in immunoflorosence examination. Because of systemic sings and symptoms (WBC: 11,400, Hb: 8.9 g/dL, Hct: %27, ESR: 120 mm/h, CRP: 96 mg/L, AST: 43 U/L, ALT: 31 U/L, GGT: 200 U/L, ALP 314 U/L), investigations (liver biopsy, excisional lymph node biopsy, bone marrow biopsy) to exclude systemic causes were caried out. So, systemic causes such as lymphoma, tuberculosis and sarcoidosis were excluded, and diagnosis of adult Still’s disease was made (ferritin: 2122 ng/mL). With the treatment of indomethazin and 1 mg/kg oral prednisolon, fever and disordered urine findings returned to normal. Adult Still’s disease is a systemic disease with unknown etiology and pathogenesis. Since it does not have spesific clinical and laboratory findings, diagnosis is made by excluding other diseases. It is characterized by high level of ferritin. Although persistant proteinuria other than intermittan proteinuria accompanying fever episodes was rarely reported, mostly they are related to amiloidosis. With our case, another rare cause of Still’s disease is emphasized.