title: Fibrillary glomerulonephritis associated with monoclonal gammopathy of undetermined significance showing lambda-type Bence Jones protein.
abstract: A 79-year-old woman was admitted to our hospital because of leg edema due to a nephrotic syndrome. Urinary and serum immunoelectrophoresis showed positive for the lambda type of Bence Jones protein. A bone marrow aspiration test revealed mild plasmacytosis (6.4% of the total cells). These findings confirmed her diagnosis of monoclonal gammopathy of undetermined significance (MGUS). Her renal biopsy specimen revealed mild mesangial cell proliferation and an increase in the mesangial matrix. Immunofluorescence studies showed positive staining for IgG, IgA, C3, and kappa and lambda light chains in the capillary wall and mesangium area. Electron microscopy showed that the electron deposits in the thickened basement membrane were formed by randomly arranged 16- to 18-nm nonbranching fibrils. A Congo red stain for amyloid was negative. These findings corresponded with the diagnosis of fibrillary glomerulonephritis. Therefore, this case showed a rare combination of fibrillary glomerulonephritis and MGUS.
authors.affiliation: Second Department of Internal Medicine, Ehime University School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Nagao
authors.forename: Takafumi
authors.initials: T
authors.lastname: Okura
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Miyoshi
authors.forename: Sanae
authors.initials: S
authors.lastname: Watanabe
authors.forename: Seiko
authors.initials: S
authors.lastname: Manabe
authors.forename: Mie
authors.initials: M
authors.lastname: Kurata
authors.forename: Jun
authors.initials: J
authors.lastname: Irita
authors.forename: Tomikazu
authors.initials: T
authors.lastname: Fukuoka
authors.forename: Jitsuo
authors.initials: J
authors.lastname: Higaki
mesh_terms: D000368:Aged; D001485:Basement Membrane / Q000648:ultrastructure; D001536:Bence Jones Protein / Q000652:urine*; D005260:Female; D005455:Fluorescent Antibody Technique; D005921:Glomerulonephritis / Q000150:complications* / Q000473:pathology / Q000652:urine; D006801:Humans; D007122:Immunoelectrophoresis; D010265:Paraproteinemias / Q000150:complications* / Q000652:urine
chemical_list: D001536:Bence Jones Protein