Volume 1, Issue 4, Pages (July 2019)

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Volume 1, Issue 4, Pages 221-225 (July 2019) Proliferative Glomerulonephritis With Monoclonal IgG3λ Deposits: A Case Report of a Rare Cause of Monoclonal Gammopathy of Renal Significance Xiao-juan Yu, Mang-ju Wang, Zi-hao Yong, Yi-yi Ma, Su-xia Wang, Fu-de Zhou, Ming-hui Zhao Kidney Medicine Volume 1, Issue 4, Pages 221-225 (July 2019) DOI: 10.1016/j.xkme.2019.06.004 Copyright © 2019 The Authors Terms and Conditions

Figure 1 Patient’s first kidney biopsy findings. (A) Immunofluorescence shows granular C3 deposition in the mesangial area and along the capillary wall on frozen tissue (original magnification, ×200). (B) Light microscopy shows membranoproliferative glomerulonephritis change in glomeruli (periodic methenamine silver and Masson trichrome staining; original magnification, ×400). (C) Electron-dense deposits in the mesangial and subendothelial areas on electronic microscopy (original magnification, ×5,000). (D) Immunoglobulin G1 (IgG1) and (E) IgG2 were negative by immunohistochemistry staining on paraffin tissue (D, E: original magnification, ×400). (F) IgG3 deposition in the mesangial area and along the capillary wall by immunohistochemistry staining on paraffin tissue (original magnification, ×400). (G) IgG4 was negative by immunohistochemistry staining on paraffin tissue (original magnification, ×400). Kidney Medicine 2019 1, 221-225DOI: (10.1016/j.xkme.2019.06.004) Copyright © 2019 The Authors Terms and Conditions

Figure 2 Clinical data for the patient. Abbreviations: BD, bortezomib and dexamethasone; CYC, cyclophosphamide; IFE, immunofixation electrophoresis; Rd, lenalidomide and dexamethasone. Kidney Medicine 2019 1, 221-225DOI: (10.1016/j.xkme.2019.06.004) Copyright © 2019 The Authors Terms and Conditions

Figure 3 Patient’s second kidney biopsy findings. Immunofluorescence showed (A) granular immunoglobulin G (IgG), (B) granular C3, (C) granular C1q, and (D) granular IgG3 deposition in the mesangial area and along the capillary wall on frozen tissue; (E) trace κ light chain deposition on frozen tissue; and (F) strong granular λ light chain deposition in the mesangial area and along the capillary wall on frozen tissue (A-F: original magnification, ×200). (G) Light microscopy shows membranoproliferative glomerulonephritis change in glomeruli (periodic methenamine silver and Masson trichrome stain; original magnification, ×400). (H) Electron-dense deposits in the mesangial, subendothelial, and segmental subepithelial areas on electron microscopy (original magnification, ×5,000). Kidney Medicine 2019 1, 221-225DOI: (10.1016/j.xkme.2019.06.004) Copyright © 2019 The Authors Terms and Conditions