title: Acute renal failure due to IgM-lambda glomerular thrombi and MPGN-like lesions in a patient with angioimmunoblastic T-Cell lymphoma.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Rheumatology, Aichi Medical University School of Medicine, Aichi, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Miura
authors.forename: Keisuke
authors.initials: K
authors.lastname: Suzuki
authors.forename: Masabumi
authors.initials: M
authors.lastname: Yoshino
authors.forename: Wataru
authors.initials: W
authors.lastname: Kitagawa
authors.forename: Harutaka
authors.initials: H
authors.lastname: Yamada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohtani
authors.forename: Kensuke
authors.initials: K
authors.lastname: Joh
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Imai
mesh_terms: 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*
chemical_list: D007075:Immunoglobulin M