Limits...
Proliferative glomerulonephritis with monoclonal immunoglobulin deposition disease: The utility of routine staining with immunoglobulin light chains.

Gowda KK, Nada R, Ramachandran R, Joshi K, Tewari R, Kohli HS, Jha V, Gupta KL - Indian J Nephrol (2015 Nov-Dec)

Bottom Line: None of these patients had overt multiple myeloma.The predominant histologic pattern was membranoproliferative with all the biopsies showing IgG3 Kappa deposits on IF.The deposits were primarily subendothelial on electron microscopy.

View Article: PubMed Central - PubMed

Affiliation: Department of Histopathology, PGIMER, Chandigarh, India.

ABSTRACT
Proliferative glomerulonephritis occurring as a consequence of monoclonal glomerular deposits of IgG is uncommon. It is a form of renal involvement in monoclonal gammopathy that mimics immune complex glomerulonephritis. Here, we report the first series of proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) from the Indian subcontinent highlighting use of light chain immunofluorescence (IF) in routine renal biopsy interpretation. We retrieved 6 patients diagnosed as proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) out of 160 biopsies (3.7%) with membranoproliferative patterns over 5 1/2 years (2009-2014), one of whom had recurrence 6 months post-renal transplant. Four (67%) patients presented with rapidly progressive renal failure and two (33%) with nephrotic syndrome. None of these patients had overt multiple myeloma. The predominant histologic pattern was membranoproliferative with all the biopsies showing IgG3 Kappa deposits on IF. The deposits were primarily subendothelial on electron microscopy.

No MeSH data available.


Related in: MedlinePlus

Photomicrograph (case 3) showing MPGN pattern with segmental endocapillary proliferation (PAS, ×40). The glomerulus showed deposits of IgG and kappa only along glomerular capillary loops and in mesangium (direct immunofluorescence, fluorescein, IgG, kappa, lambda, ×40)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4663771&req=5

Figure 1: Photomicrograph (case 3) showing MPGN pattern with segmental endocapillary proliferation (PAS, ×40). The glomerulus showed deposits of IgG and kappa only along glomerular capillary loops and in mesangium (direct immunofluorescence, fluorescein, IgG, kappa, lambda, ×40)

Mentions: The kidney biopsies included mean of 15.5 glomeruli (range 8–42 glomeruli), of which on an average 4.2 glomeruli were globally sclerotic [Table 2]. The histologic pattern, seen was membranoproliferative glomerulonephritis in all cases (100%) characterized by diffuse and global double-contoured glomerular capillary walls with mesangial cell interposition and mesangial expansion by increased mesangial cell number and matrix [Figure 1]. Segmental endocapillary proliferation was present in four (67%) cases. None of the cases showed crescents. One (16%) patient had in addition features of diabetic glomerulosclerosis (Case 3). The degree of tubular atrophy and interstitial fibrosis was moderate and severe in 2 cases each while it was mild and absent in 1 case each. Arteriosclerosis ranged from mild (n-2) to moderate (n-2) to severe (n-2). Interstitial inflammation ranged from mild (n-2) to moderate (n-4).


Proliferative glomerulonephritis with monoclonal immunoglobulin deposition disease: The utility of routine staining with immunoglobulin light chains.

Gowda KK, Nada R, Ramachandran R, Joshi K, Tewari R, Kohli HS, Jha V, Gupta KL - Indian J Nephrol (2015 Nov-Dec)

Photomicrograph (case 3) showing MPGN pattern with segmental endocapillary proliferation (PAS, ×40). The glomerulus showed deposits of IgG and kappa only along glomerular capillary loops and in mesangium (direct immunofluorescence, fluorescein, IgG, kappa, lambda, ×40)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663771&req=5

Figure 1: Photomicrograph (case 3) showing MPGN pattern with segmental endocapillary proliferation (PAS, ×40). The glomerulus showed deposits of IgG and kappa only along glomerular capillary loops and in mesangium (direct immunofluorescence, fluorescein, IgG, kappa, lambda, ×40)
Mentions: The kidney biopsies included mean of 15.5 glomeruli (range 8–42 glomeruli), of which on an average 4.2 glomeruli were globally sclerotic [Table 2]. The histologic pattern, seen was membranoproliferative glomerulonephritis in all cases (100%) characterized by diffuse and global double-contoured glomerular capillary walls with mesangial cell interposition and mesangial expansion by increased mesangial cell number and matrix [Figure 1]. Segmental endocapillary proliferation was present in four (67%) cases. None of the cases showed crescents. One (16%) patient had in addition features of diabetic glomerulosclerosis (Case 3). The degree of tubular atrophy and interstitial fibrosis was moderate and severe in 2 cases each while it was mild and absent in 1 case each. Arteriosclerosis ranged from mild (n-2) to moderate (n-2) to severe (n-2). Interstitial inflammation ranged from mild (n-2) to moderate (n-4).

Bottom Line: None of these patients had overt multiple myeloma.The predominant histologic pattern was membranoproliferative with all the biopsies showing IgG3 Kappa deposits on IF.The deposits were primarily subendothelial on electron microscopy.

View Article: PubMed Central - PubMed

Affiliation: Department of Histopathology, PGIMER, Chandigarh, India.

ABSTRACT
Proliferative glomerulonephritis occurring as a consequence of monoclonal glomerular deposits of IgG is uncommon. It is a form of renal involvement in monoclonal gammopathy that mimics immune complex glomerulonephritis. Here, we report the first series of proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) from the Indian subcontinent highlighting use of light chain immunofluorescence (IF) in routine renal biopsy interpretation. We retrieved 6 patients diagnosed as proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) out of 160 biopsies (3.7%) with membranoproliferative patterns over 5 1/2 years (2009-2014), one of whom had recurrence 6 months post-renal transplant. Four (67%) patients presented with rapidly progressive renal failure and two (33%) with nephrotic syndrome. None of these patients had overt multiple myeloma. The predominant histologic pattern was membranoproliferative with all the biopsies showing IgG3 Kappa deposits on IF. The deposits were primarily subendothelial on electron microscopy.

No MeSH data available.


Related in: MedlinePlus