Light Chain Deposition Disease After Renal Transplantation Sekiko Taneda, MD, Kazuho Honda, MD, Shigeru Horita, MS, Ichiro Koyama, MD, Satoshi Teraoka, MD, Hideaki Oda, MD, Yutaka Yamaguchi, MD  American Journal of Kidney Diseases  Volume 52, Issue 3, Pages 621-625 (September 2008) DOI: 10.1053/j.ajkd.2008.02.370 Copyright © 2008 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 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. American Journal of Kidney Diseases 2008 52, 621-625DOI: (10.1053/j.ajkd.2008.02.370) Copyright © 2008 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 (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). American Journal of Kidney Diseases 2008 52, 621-625DOI: (10.1053/j.ajkd.2008.02.370) Copyright © 2008 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 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. American Journal of Kidney Diseases 2008 52, 621-625DOI: (10.1053/j.ajkd.2008.02.370) Copyright © 2008 National Kidney Foundation, Inc. Terms and Conditions