title: A large-sized bubbling appearance of the glomerular basement membrane in a patient with pulmonary limited AL amyloidosis and a past history of lupus nephritis.
abstract: We report an unusual pathological finding, a large-sized bubbling appearance of the glomerular basement membrane (GBM), in a patient with pulmonary limited AL amyloidosis and a past history of lupus nephritis. The first renal biopsy specimen from 10 years ago, when systemic lupus erythematosus was diagnosed, demonstrated mild mesangial proliferation and subepithelial deposits (WHO classification: III + V). Light microscopy of the current biopsy using periodic acid methenamine silver (PAMS) stain demonstrated a large-sized bubbling appearance of the GBM; however, very weak immunoglobulin and complement deposition was observed in immunofluorescence studies. Routine electron microscopy demonstrated partial subendothelial expansion with electron-lucent materials, but no electron-dense deposits or amyloid fibrils. Electron microscopy with PAMS stain revealed electron-lucent endothelial scalloping, including some cellular components and microspheres in the GBM; however, it is not clear if these materials are derived from endothelial cells. One possibility is that these unique findings represent a recovery phase of lupus membranous nephritis; another is that these findings correspond to a new disease entity.
authors.affiliation: Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University, School of Medicine, Nagakute, Aichi 480-1195, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Suga
authors.forename: Naoto
authors.initials: N
authors.lastname: Miura
authors.forename: Yuko
authors.initials: Y
authors.lastname: Uemura
authors.forename: Toshinobu
authors.initials: T
authors.lastname: Nakamura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Morita
authors.forename: Shogo
authors.initials: S
authors.lastname: Banno
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Imai
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D001706:Biopsy; D005260:Female; D005455:Fluorescent Antibody Technique; D050533:Glomerular Basement Membrane / Q000473:pathology* / Q000648:ultrastructure; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D008181:Lupus Nephritis / Q000150:complications* / Q000473:pathology; D008854:Microscopy, Electron; D014057:Tomography, X-Ray Computed