Light Chain Deposition Disease After Renal Transplantation

Clinical course of the patient. Abbreviations: CsA, cyclosporine A; FK, tacrolimus; MMF, mycophenolate mofetil; MP, methylprednisolone; DSG, 15-deoxyspergualin; sCr, serum creatinine; U-P, urinary-protein; Bx, graft biopsy; Tx, transplantation; AZP, azathioprine; HD, hemodialysis; Ccr, creatinine clearance.

(A-F) Pathological findings of the graft biopsy performed on day 1,540. (A) Light microscopy shows diffuse interstitial fibrosis with tubular atrophy without evidence of rejection. Tubular basement membranes (TBMs) were thickened and tortuous (periodic acid–Schiff; original magnification ×200). (B) Glomeruli show typical nodular lesions resembling those in diabetic glomerulosclerosis. The basement membrane of Bowman's capsule and proximal and distal tubules were irregularly thickened. Severe arteriolar hyalinosis was noted (periodic acid-silver methenamine; original magnification ×400). (C) Immunofluorescence study shows intense κ staining in the nodular glomerular lesions, glomerular capillaries, tubules, Bowman's capsule, and small-vessel walls (original magnification ×400). (D) Immunofluorescence study shows negative staining for λ light chains (original magnification ×400). (E, F) Electron microscopy shows fine granular electron-dense deposits along the (E) glomerular basement membrane and (F) TBM (original magnification: [E] ×6,000; [F] ×7,000). (F inset). Electron-dense material along the TBM shows a granular to powdery appearance (original magnification ×10,000).

Serial changes in (A, D, H, L) glomerular histological characteristics, (E, I, M) immunofluorescent staining for κ light chains, and electron microscopy of the (B, F, J, N) glomerular and (C, G, K, O) tubular basement membranes. (A-C) Day 0, (D-G) day 43 (biopsy [Bx] 3), (H-K) day 774 (Bx 4), and (L-O) day 913 (Bx 5). Immunofluorescent staining was not performed in the 0-hour biopsy because frozen sections were not obtained.