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2014 ; 3
(2
): 162-166
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Probable light- and heavy-chain deposition disease in a patient with nodular
diabetic glomerulosclerosis
#MMPMID28509191
Nakamura N
; Katafuchi R
; Watanabe I
; Kuroki Y
; Ishida I
; Hori K
CEN Case Rep
2014[Nov]; 3
(2
): 162-166
PMID28509191
show ga
We report a case of probable light- and heavy-chain deposition disease (LHCDD) in
a diabetic patient, a rare and educational case. The patient was a 71-year-old
man having a long history of uncontrolled diabetes mellitus with retinopathy. He
showed heavy proteinuria and renal insufficiency, and did not have paraproteins.
Renal biopsy revealed nodular glomerulosclerosis with severe mesangial widening
and microaneurysm. Immunofluorescence (IF) showed weak staining of kappa light
chain, IgG and C1q along glomerular basement membrane (GBM). At first, we
interpreted these IF findings to be nonspecific, thus we diagnosed as diabetic
nodular glomerulosclerosis. Later, we recognized one of a few case reports of
monoclonal immunoglobulin deposition disease (MIDD) in diabetic patients, and
reconsidered the first diagnosis. The added electron microscopy (EM) showed
obvious electron-dense materials in GBM, while tubular basement membrane deposits
were not identified. A concurrence of LHCDD and diabetic nodular
glomerulosclerosis may be suggested in this case. Like this case, IF staining in
MIDD is often weak, so it is difficult to diagnose MIDD accurately without EM.
Reports of MIDD in diabetic patients are extremely rare, possibly due to being
often overlooked. This case emphasizes that overall pathological examination
including IF and EM is important for the accurate differentiation of nodular
glomerulosclerosis, even in diabetic patients.