Unique Renal Manifestation of Type I Cryoglobulinemia, With Massive Crystalloid Deposits in Glomerular Histiocytes, Podocytes, and Endothelial Cells.
| Autor: | Hoelbeek J; From the Departments of Pathology j.j.hoelbeek@amc.uva.nl., Duivenvoorden R; Clinical Immunology and Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands., de Boer OJ; From the Departments of Pathology., Claessen N; From the Departments of Pathology., Van den Bergh Weerman MA; From the Departments of Pathology., Roelofs JJ; From the Departments of Pathology., Kers J; From the Departments of Pathology., Ten Berge IJ; Clinical Immunology and Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands., Florquin S; From the Departments of Pathology. |
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| Jazyk: | angličtina |
| Zdroj: | American journal of clinical pathology [Am J Clin Pathol] 2016 Feb; Vol. 145 (2), pp. 282-5. Date of Electronic Publication: 2016 Jan 21. |
| DOI: | 10.1093/ajcp/aqv027 |
| Abstrakt: | Objectives: We describe a 62-year-old woman with a 15-year history of a plasma cell dyscrasia (monoclonal IgGκ), manifested by type I cryoglobulinemia and dermal vasculitis. Methods: In addition to the clinical examinations, light microscopy with immunohistochemistry, sequential multicolor immunohistochemistry, and electron microscopy were used to characterize the crystalline deposits. Results: At initial presentation and for a later flare, she was treated with cyclophosphamide and prednisolone with good clinical response. She had renal function decline, microscopic hematuria, and proteinuria. A renal biopsy specimen revealed the presence of glomerular macrophages and duplication of the capillary walls with cellular interposition. Glomerular cells contained abundant needle-shaped eosinophilic crystalline inclusions positive for κ light chain. Electron microscopy confirmed the presence of intracytoplasmatic crystalline structures in endothelial cells, podocytes, and macrophages but not in the tubular epithelium. Rituximab treatment was started. At follow-up (now up to 6 months), renal function remained stable. Conclusions: This patient displays a unique renal manifestation of type I cryoglobulinemia related to a plasma cell dyscrasia. (© American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.) |
| Databáze: | MEDLINE |
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