Abstract
Renal organized or structured deposits are much less frequent than those with usual type immunocomplex deposits and are encountered in a wide variety of primary and systemic disorders. It has been suggested that immunoglobulins (Igs) are responsible for organized deposits. We report 5 cases who have been diagnosed and treated in our hospital. Patients were aged 52 to 72 years, three of them were males and had variable degree of renal function, from normal serum creatinine to uraemia. Proteinuria was detected in all patients while monoclonal component was present only in the serum of one subject. Ultrastructural analysis of renal specimens revealed organized deposits. Diagnoses that were made are the following: membranoproliferative glomerulonephritis with finger print, immunotactoid glomerulopathy, membranoproliferative glomerulonephritis with arched deposits, primary amyloidosis and light chain deposition disease. In systemic disorders ultrastructural pathology could be particularly valuable for correct deposits classification, precise localization and pattern of deposition of Igs.
Highlights
Differential diagnosis of renal organized or structured deposits is a matter of debate [1]
In systemic disorders ultrastructural pathology could be valuable for correct deposits classification, precise localization and pattern of deposition of Igs
We report 5 cases of renal syndromes in which ultrastructural analysis of kidney specimens had a crucial role distinguishing between usual type immunocomplex deposits and organized ones and this information could be important for clinical management of patients
Summary
Differential diagnosis of renal organized or structured deposits is a matter of debate [1]. Case 2 A 72-year-old Caucasian man was hospitalized because of acute renal failure (serum creatinine 4.4 mg/dl). His clinical history included arthralgias, hypertension, necrotizing leucocytoclastic vasculitis and in his serum a monoclonal component was identified (IgAλ 9.8%). Case 4 A 63-year-old Caucasian man was admitted because of nephrotic syndrome and renal failure (serum creatinine 1.6 mg/dl). Light microscopy examination showed smooth and continuous deposition of eosinophil material in the tubular basement membrane, mild thickening and stiffness of the glomerular basement membrane, and increase of the mesangial matrix. Bone marrow aspiration and bone biopsy were performed, and histologic examination of the specimens confirmed the diagnosis of monoclonal immunoglobulin deposition disease associated to kappa light chain multiple myeloma
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