Acute renal failure due to IgM-lambda glomerular thrombi and MPGN-like lesions in a patient with angioimmunoblastic T-Cell lymphoma.
A 70-year-old man with angioimmunoblastic T-cell lymphoma developed acute renal failure. Laboratory data showed decreased levels of serum C3, C4, and CH50, elevated immunoglobulin M (IgM) levels, and the presence of cryoglobulinemia (IgM-lambda). Renal biopsy showed membranoproliferative glomerulonephritis-like lesions with azan-red-stained thrombi in the glomerular capillary lumen. Immunofluorescence showed that IgM-lambda stained strongly in the glomerular capillary lumen, equal to the azan-red-stained thrombi, whereas C3 and C4 staining was negative. Electron microscopy showed electron-dense deposits in the subendothelial space and glomerular thrombi lacking fine fibrillar structure. These findings suggest that cryoglobulin, which consists of monoclonal IgM-lambda, induced glomerular thrombi and acute renal failure in a patient with angioimmunoblastic T-cell lymphoma.
Miura
Naoto
N
Department of Internal Medicine, Division of Nephrology and Rheumatology, Aichi Medical University School of Medicine, Aichi, Japan.
Suzuki
Keisuke
K
Yoshino
Masabumi
M
Kitagawa
Wataru
W
Yamada
Harutaka
H
Ohtani
Hiroshi
H
Joh
Kensuke
K
Imai
Hirokazu
H
D058186:Acute Kidney Injury; D000368:Aged; D006801:Humans; D007119:Immunoblastic Lymphadenopathy / Q000150:complications*; D007075:Immunoglobulin M / Q000032:analysis; D007678:Kidney Glomerulus / Q000473:pathology; D016399:Lymphoma, T-Cell / Q000150:complications*; D008297:Male; D013927:Thrombosis / Q000209:etiology* / Q000276:immunology*
D007075:Immunoglobulin M