Case Report
Copyright ©The Author(s) 2021.
World J Clin Cases. Apr 6, 2021; 9(10): 2357-2366
Published online Apr 6, 2021. doi: 10.12998/wjcc.v9.i10.2357
Figure 1
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Figure 1 Part of the interstitial region was infiltrated by inflammatory cells. A and B: Section of the kidney obtained at biopsy showed proliferative lesions of the glomeruli (A: Hematoxylin and eosin staining; B: Periodic acid-Schiff-methenamine silver staining). Original magnification × 400; C and D: Electron-dense deposits were observed in the subendothelial and mesangial areas by electron microscopy.
Figure 2
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Figure 2 Immunofluorescence staining. A and B: Immunofluorescence staining revealed positive petaloid deposition of (A) immunoglobulin G (IgG) and (B) C3; C-F: Immunofluorescence staining for IgG subclasses showed intense positivity for (E) IgG3 and negative staining for (C) IgG1, (D) IgG2, and (F) IgG4; G and H: Strong glomerular staining for κ light chain (G) and weak staining for λ light chain (H) were observed. Original magnification, × 400.
Figure 3
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Figure 3 Immunofluorescence analyses. A-D: Immunofluorescence staining for immunoglobulin G (IgG) subclasses shows intense positivity for (C) IgG3 and negative staining for (A) IgG1, (B) IgG2, and (D) IgG4; E and F: Strong glomerular staining for κ light chain (E) and weak staining for λ light chain (F) were observed. Original magnification, × 400.
Figure 4
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Figure 4 Trends of the urine protein-to-creatinine ratio, serum creatinine, hemoglobin, serum albumin levels, and urine free light chain ratio since the first day of initiation of the bortezomib (B) + cyclophosphamide (C) + dexamethasone (D) scheme. A: Serum albumin; B: Serum creatinine; C: Heamoglobin; D: Urine protein-to-creatinine ratio; E: Urine free light chain ratio.
Figure 5
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Figure 5 Diagnosis algorithm of proliferative glomerulonephritis with monoclonal immunoglobulin G deposits. PGN: Proliferative glomerulonephritis; IC: Immune complexes; LCs: Light chains; MPGN: Membranoproliferative glomerulonephritis; MIDD: Monoclonal immunoglobulin deposition disease; MGRS: Monoclonal gammopathy of renal significance; LCDD: Light-chain deposition disease; HCDD: Heavy-chain deposition disease; LHCDD: Light-and heavy-chain deposition disease; PGNMID: Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits; Type 1 CGN: Type 1 cryoglobulinemic glomerulonephritis; IT: Immunotactoid glomerulonephritis; MM: Multiple myeloma.