Skip to main content

Advertisement

SpringerLink
Log in

The clinicopathological characteristics and outcomes of IgA nephropathy with predominant lambda or kappa light-chain deposition

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

IgA nephropathy (IgAN) patients with monoclonal light-chain deposition may be at potential risk of hematological progression. However, whether the clinical characteristics of the patients with predominant lambda or kappa light-chain deposition were consistent with monoclonal light-chain deposition is limited to anecdotes.

Methods

We retrospectively studied patients in whom immunofluorescence showed IgA-alone deposits (n = 617) between January 2016 and January 2020. We divided the patients into two groups, the predominant lambda or kappa light-chain deposition group and the control group. Predominant lambda or kappa light-chain deposition was defined as the deposition intensity of kappa or lambda being + − and the other deposition intensity being ≥ 2 + .

Results

Nineteen patients had predominant lambda or kappa light-chain deposition. The patients had a median age of 32 years. The median proteinuria was 0.9 g/day. The median eGFR was 79.8 ml/min per 1.73 m2. Two patients had a mildly abnormal FLC ratio, but serum immunofixation electrophoresis showed polyclonal immunoglobulin. Eighteen patients showed lambda light chain-dominated deposition. In electron microscopy, organized structures in dense deposits were not observed in all patients. Nine patients with proteinuria ≥ 1.0 g/day received corticosteroids and immunosuppressants. The median follow-up time was 21 months. The rate of proteinuria remission was 50%. The clinical and pathological characteristics and outcomes were not significantly different between the predominant lambda or kappa light-chain deposition group and the control group.

Conclusion

The result for IgAN patients with predominant kappa/lambda light-chain deposition seemed to be the same as that of IgAN patients with light-chain codeposition. However, as this was a single-center study with a small size, further multicenter studies and long-term follow-up are needed to confirm our findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Trimarchi H, Barratt J, Cattran DC, Cook HT, Coppo R, Haas M, Liu ZH, Roberts IS, Yuzawa Y, Zhang H, Feehally J, Ig ANCWGotIINN, the Renal Pathology S, Conference P (2017) Oxford classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int 91(5):1014–1021. https://doi.org/10.1016/j.kint.2017.02.003

    Article  PubMed  Google Scholar 

  2. Nagae H, Tsuchimoto A, Tsuruya K, Kawahara S, Shimomura Y, Noguchi H, Masutani K, Katafuchi R, Kitazono T (2017) Clinicopathological significance of monoclonal IgA deposition in patients with IgA nephropathy. Clin Exp Nephrol 21(2):266–274. https://doi.org/10.1007/s10157-016-1275-7

    Article  CAS  PubMed  Google Scholar 

  3. Vignon M, Cohen C, Faguer S, Noel LH, Guilbeau C, Rabant M, Higgins S, Hummel A, Hertig A, Francois H, Lequintrec M, Vilaine E, Knebelmann B, Pourrat J, Chauveau D, Goujon JM, Javaugue V, Touchard G, El Karoui K, Bridoux F (2017) The clinicopathologic characteristics of kidney diseases related to monotypic IgA deposits. Kidney Int 91(3):720–728. https://doi.org/10.1016/j.kint.2016.10.026

    Article  CAS  PubMed  Google Scholar 

  4. Jennette JC (1988) The immunohistology of IgA nephropathy. Am J Kidney Dis 12(5):348–352. https://doi.org/10.1016/s0272-6386(88)80022-2

    Article  CAS  PubMed  Google Scholar 

  5. Lai KN, Chan KW, Mac-Moune F, Ho CP, Yan KW, Lam CW, Vallance-Owen J (1986) The immunochemical characterization of the light chains in the mesangial IgA deposits in IgA nephropathy. Am J Clin Pathol 85(5):548–551. https://doi.org/10.1093/ajcp/85.5.548

    Article  CAS  PubMed  Google Scholar 

  6. Coppo R (2017) Clinical and histological risk factors for progression of IgA nephropathy: an update in children, young and adult patients. J Nephrol 30(3):339–346. https://doi.org/10.1007/s40620-016-0360-z

    Article  CAS  PubMed  Google Scholar 

  7. Lai KN, Lai FM, Lo ST, Lam CW (1988) Light chain composition of IgA in IgA nephropathy. Am J Kidney Dis 11(5):425–429. https://doi.org/10.1016/s0272-6386(88)80056-8

    Article  CAS  PubMed  Google Scholar 

  8. Haas M (2005) Histology and immunohistology of IgA nephropathy. J Nephrol 18(6):676–680

    PubMed  Google Scholar 

  9. Orfila C, Rakotoarivony J, Manuel Y, Suc JM (1988) Immunofluorescence characterization of light chains in human nephropathies. Virchows Archiv A Pathol Anat Histopathol 412(6):591–594. https://doi.org/10.1007/BF00844295

    Article  CAS  Google Scholar 

  10. Smith SM (1990) IgA nephropathy: characterization of the light chains. Clin Nephrol 34(2):93–94

    CAS  PubMed  Google Scholar 

  11. Lai KN, Tang SC, Schena FP, Novak J, Tomino Y, Fogo AB, Glassock RJ (2016) IgA nephropathy. Nat Rev Dis Primers 2:16001. https://doi.org/10.1038/nrdp.2016.1

    Article  PubMed  Google Scholar 

  12. Katzmann JA, Kyle RA, Benson J, Larson DR, Snyder MR, Lust JA, Rajkumar SV, Dispenzieri A (2009) Screening panels for detection of monoclonal gammopathies. Clin Chem 55(8):1517–1522. https://doi.org/10.1373/clinchem.2009.126664

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Leung N, Bridoux F, Batuman V, Chaidos A, Cockwell P, D’Agati VD, Dispenzieri A, Fervenza FC, Fermand JP, Gibbs S, Gillmore JD, Herrera GA, Jaccard A, Jevremovic D, Kastritis E, Kukreti V, Kyle RA, Lachmann HJ, Larsen CP, Ludwig H, Markowitz GS, Merlini G, Mollee P, Picken MM, Rajkumar VS, Royal V, Sanders PW, Sethi S, Venner CP, Voorhees PM, Wechalekar AD, Weiss BM, Nasr SH (2019) The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group. Nat Rev Nephrol 15(1):45–59. https://doi.org/10.1038/s41581-018-0077-4

    Article  PubMed  Google Scholar 

  14. Hutchison CA, Plant T, Drayson M, Cockwell P, Kountouri M, Basnayake K, Harding S, Bradwell AR, Mead G (2008) Serum free light chain measurement aids the diagnosis of myeloma in patients with severe renal failure. BMC Nephrol 9:11. https://doi.org/10.1186/1471-2369-9-11

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Bhutani G, Nasr SH, Said SM, Sethi S, Fervenza FC, Morice WG, Kurtin PJ, Buadi FK, Dingli D, Dispenzieri A, Gertz MA, Lacy MQ, Kapoor P, Kumar S, Kyle RA, Rajkumar SV, Leung N (2015) Hematologic characteristics of proliferative glomerulonephritides with nonorganized monoclonal immunoglobulin deposits. Mayo Clin Proc 90(5):587–596. https://doi.org/10.1016/j.mayocp.2015.01.024

    Article  CAS  PubMed  Google Scholar 

  16. Lai KN, To WY, Li PK, Leung JC (1996) Increased binding of polymeric lambda-IgA to cultured human mesangial cells in IgA nephropathy. Kidney Int 49(3):839–845. https://doi.org/10.1038/ki.1996.116

    Article  CAS  PubMed  Google Scholar 

  17. Leung JC, Tang SC, Chan DT, Lui SL, Lai KN (2002) Increased sialylation of polymeric lambda-IgA1 in patients with IgA nephropathy. J Clin Lab Anal 16(1):11–19. https://doi.org/10.1002/jcla.2035

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank the staff of the department of Nephrology, Xijing Hospital.

Funding

This study was supported by grants from the Natural Science Basic Research Program of Shaanxi province (2021JM-233).

Author information

Author notes

  1. Shiren Sun, Wang Di and Rong Li contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi’an, 710032, Shaanxi, China

    Shiren Sun, Wang Di, Rong Li, Xiaoxia Yang, Qin Jia, Chunmei Liu & Feng Ma

  2. Department of Nephrology, Xi’an Jiao Tong University-Affiliated Honghui Hospital, Xi’an, 710054, Shaanxi, China

    Feng Ma

Authors
  1. Shiren Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wang Di
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiaoxia Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qin Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chunmei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Feng Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Feng Ma.

Ethics declarations

Conflict of interest

All the authors declared no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sun, S., Di, W., Li, R. et al. The clinicopathological characteristics and outcomes of IgA nephropathy with predominant lambda or kappa light-chain deposition. Int Urol Nephrol 54, 1705–1712 (2022). https://doi.org/10.1007/s11255-021-03062-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-021-03062-8

Keywords

Search

Navigation