Journal of Pathology and Translational Medicine

Case Studies

A case of monoclonal gammopathy of renal significance presenting as atypical amyloidosis with IgA lambda paraproteinemia: Chankyung Kim, John Brealey, Anjelo Jobert, James Nolan; J Pathol Transl Med. 2020;54(6):504-507. Published online November 9, 2020; DOI: https://doi.org/10.4132/jptm.2020.09.18

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Monoclonal gammopathy of renal significance is defined as any B cell or plasma cell clonal lymphoproliferation which neither causes tumor complications nor meets any current hematological criteria for specific therapy, with one or more kidney lesions related to the produced monoclonal immunoglobulin, such as amyloidosis. A 50-year-old male presented with heavy proteinuria and blood tests showing IgA and Lambda paraproteinemia. Light microscopy showed mesangial eosinophilic ground substance extending into the capillary loops, and positive staining within the glomeruli and vessel walls for amyloid P immunohistochemistry was also noted. Immunofluorescence showed positive staining for IgA and Lambda in the mesangia and capillary loops. Electron microscopy exhibited organized fibrils measuring 4–5 nm in diameter in the mesangia, glomerular basement membranes and vessel walls. We interpreted the overall findings as atypical renal amyloidosis with IgA and Lambda deposition on immunofluorescence. Further amyloid typing using laser microdissection-liquid chromatography and mass spectrometry will be useful.

Citations

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AB-Amy: machine learning aided amyloidogenic risk prediction of therapeutic antibody light chains
Yuwei Zhou, Ziru Huang, Yushu Gou, Siqi Liu, Wei Yang, Hongyu Zhang, Anthony Mackitz Dzisoo, Jian Huang
Antibody Therapeutics.2023; 6(3): 147. CrossRef

Concurrent Anti-glomerular Basement Membrane Nephritis and IgA Nephropathy: Kwang-Sun Suh, Song-Yi Choi, Go Eun Bae, Dae Eun Choi, Min-kyung Yeo; J Pathol Transl Med. 2019;53(6):399-402. Published online September 16, 2019; DOI: https://doi.org/10.4132/jptm.2019.08.05

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Abstract PDF Supplementary Material

Anti–glomerular basement membrane (GBM) nephritis is characterized by circulating anti-GBM antibodies and crescentic glomerulonephritis (GN) with deposition of IgG along the GBM. In a limited number of cases, glomerular immune complexes have been identified in anti-GBM nephritis. A 38-year-old female presented azotemia, hematuria, and proteinuria without any pulmonary symptoms. A renal biopsy showed crescentic GN with linear IgG deposition along the GBM and mesangial IgA deposition. The patient was diagnosed as concurrent anti-GBM nephritis and IgA nephropathy. Therapies with pulse methylprednisolone and cyclophosphamide administration were effective. Concurrent cases of both anti-GBM nephritis and IgA nephropathy are rare among cases of anti-GBM diseases with deposition of immune complexes. This rare case of concurrent anti-GBM nephritis and IgA nephropathy with literature review is noteworthy.

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Coexistence of anti-glomerular basement membrane disease and IgA nephropathy: an illustrative case and comprehensive literature review
Zewei Chen, Dechao Xu, Fangzheng Cui, Huihui Hou, Zhiguo Mao, Xiang Gao
Renal Failure.2024;[Epub] CrossRef
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Claudio Ponticelli, Marta Calatroni, Gabriella Moroni
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Huihui Chen, Jingjing Jin, Mei Juan Cheng, Lei He, Wei Zhou, Liping Guo, Zhe Zhe Niu, Xiang Nan Liang, Rong Fang Zhu, Yaling Bai, Jin Sheng Xu
Medicine.2023; 102(3): e32698. CrossRef
Clinical and immunological characteristics of patients with combined anti-glomerular basement membrane disease and IgA nephropathy
Cong-rong Shen, Xiao-yu Jia, Zhao Cui, Xiao-juan Yu, Ming-hui Zhao
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Case Report: Coexistence of Anti-Glomerular Basement Membrane Disease, Membranous Nephropathy, and IgA Nephropathy in a Female PatientWith Preserved Renal Function
Wei Qu, Nan Liu, Tianhua Xu, Binyao Tian, Meng Wang, Yanqiu Li, Jianfei Ma, Li Yao
Frontiers in Pharmacology.2022;[Epub] CrossRef
Great prognosis of concurrent anti-GBM disease and IgA nephropathy in a young woman: A case report
Fu Shaojie, Su Sensen, Huang Jingda, Wang Luyu, Zhang Fei, Yu Jinyu, Xu Zhonggao, Wu Hao
Medicine.2022; 101(37): e30686. CrossRef
Serodiagnosis of Anti-glomerular Basement Membrane Disease Using a Newly Developed Chemiluminescence Immunoassay
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PATHOLOGY AND RENAL OUTCOME OF THREE UNCOMMON FACES OF CRESCENTRIC GLOMERULONEPHRITIS
Keya Basu, Dipankar Sircar, Manimoy Bandopadhyay
INDIAN JOURNAL OF APPLIED RESEARCH.2021; : 7. CrossRef
Pneumocystis pneumonia secondary to intensive immunosuppression treatment for anti-GBM disease complicated with IgA nephropathy
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Original Article

Clinicopathologic Features of IgA-Dominant Postinfectious Glomerulonephritis: Tai Yeon Koo, Gheun-Ho Kim, Moon Hyang Park; Korean J Pathol. 2012;46(2):105-114. Published online April 25, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.2.105

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Abstract PDF

Background

IgA-dominant acute postinfectious glomerulonephritis (APIGN) is a recently recognized morphologic variant of APIGN, but its clinicopathologic features were not clearly characterized. We will present demographic, clinical and renal biopsy findings from seven patients with IgA-dominant APIGN with a literature review.

Methods

All renal biopsy specimens (n=1,119) processed by the Department of Pathology in Hanyang University Hospital from 2005 to 2009 were reviewed. Seven patients with IgA-dominant APIGN were identified, and their clinical data analyzed.

Results

All patients had renal failure, hematuria and proteinuria. One was diabetic, and none of the patients had previous renal diseases. Three had clinical infections at the time of presentation: 2 with methicillin-resistant Staphylococcus aureus and one with rickettsial infection. Light microscopically diffuse endocapillary proliferative and exudative glomerulonephritis was found in all cases. Immunofluorescence microscopy showed granular IgA deposits along peripheral capillary walls and in mesangium. Ultrastructurally, subepithelial 'humps' with mesangial deposits were noted. End-stage renal disease developed in two patients, chronic renal failure was stationary in two, and azotemia improved in three.

Conclusions

Various infections including rickettsiosis preceded IgA-dominant APIGN in both diabetics and nondiabetics. Because the prognosis of IgA-dominant APIGN is poor, early diagnosis based on renal biopsy is required.

Citations

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A rare case of Immunoglobulin A dominant post-infectious glomerulonephritis (IgA PIGN) in a young patient
A. Saghar, G. Klaus, B. Trutnau, M. Kömhoff, H. J. Gröne, S. Weber
BMC Nephrology.2022;[Epub] CrossRef
IgA-Dominant Infection-Associated Glomerulonephritis Following SARS-CoV-2 Infection
Aurora Pérez, Isidro Torregrosa, Luis D’Marco, Isabel Juan, Liria Terradez, Miguel Ángel Solís, Francesc Moncho, Carmen Carda-Batalla, María J. Forner, Jose Luis Gorriz
Viruses.2021; 13(4): 587. CrossRef
Relationship between blood neutrophil‐lymphocyte ratio and renal tubular atrophy/interstitial fibrosis in IgA nephropathy patients
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Journal of Clinical Laboratory Analysis.2021;[Epub] CrossRef
The Continuing Need for Electron Microscopy in Examination of Medical Renal Biopsies: Examples in Practice
Michifumi Yamashita, Mercury Y. Lin, Jean Hou, Kevin Y.M. Ren, Mark Haas
Glomerular Diseases.2021; 1(3): 145. CrossRef
Clinicopathologic features of infection-related glomerulonephritis with IgA deposits: a French Nationwide study
Elodie Miquelestorena-Standley, Charlotte Jaulerry, Marie-Christine Machet, Nolwenn Rabot, Christelle Barbet, Aurélie Hummel, Alexandre Karras, Cyril Garrouste, Thomas Crepin, Didier Ducloux, Maud Cousin, Catherine Albert, Joseph Rivalan, Emilie Cornec-Le
Diagnostic Pathology.2020;[Epub] CrossRef
IgA nephropathy and infections
Cristiana Rollino, Gisella Vischini, Rosanna Coppo
Journal of Nephrology.2016; 29(4): 463. CrossRef
<i>Staphylococcus</i>-associated Glomerulonephritis
Dong Yeol Shin, Sung Han Kim, Ji Wan Lee, Ki Ju Chang, Seung Ha Hwang, Yong Mee Cho, Soon Bae Kim
The Korean Journal of Medicine.2016; 90(2): 148. CrossRef
Use of steroid therapy in immunoglobulin A-dominant poststaphylococcal glomerulonephritis
Mahesh Eswarappa, Vijay Varma, K.C. Gurudev
Hong Kong Journal of Nephrology.2015; 17(2): 46. CrossRef
Clinicopathologic Features of IgA-Dominant Infection-Associated Glomerulonephritis: A Pooled Analysis of 78 Cases
Ru Bu, Qian Li, Zhi-yu Duan, Jie Wu, Pu Chen, Xiang-mei Chen, Guang-yan Cai
American Journal of Nephrology.2015; 41(2): 98. CrossRef
Garland-pattern postinfectious glomerulonephritis with IgA-dominant deposition
Makoto Kanno, Kenichi Tanaka, Hiroshi Kimura, Kimio Watanabe, Yoshimitsu Hayashi, Koichi Asahi, Masaaki Nakayama, Kensuke Joh, Tsuyoshi Watanabe
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