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Diagnosis of monoclonal immunotactoid glomerulopathy with positive λ chain by immunoelectron microscopy

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Abstract

We report the case of a 73-year-old-man who developed immunotactoid glomerulopathy (ITG). ITG is a rare disease characterized by proliferative glomerulonephritis and capillary wall deposits with a 10–60 nm diameter microtubular substructure. In monoclonal ITG, immunofluorescence analysis typically exhibits IgG with light chain restriction. Recent reviews recommend distinguishing monoclonal ITG from polyclonal ITG because monoclonal ITG is associated with a higher incidence of hematological disorders and better responsiveness to clone-directed therapy and renal prognosis. In our case, IgG, IgA, and IgM were negative by routine immunofluorescence; however, immunoelectron microscopy revealed positive λ chain. At 6 months after renal biopsy, the IgG λ chain was detected in the serum and urine, reflecting possible monoclonality. Therefore, it is useful to perform immunoelectron microscopy and follow-up with serum and urine protein electrophoresis and immunofixation to diagnose monoclonal ITG, even when routine immunofluorescence shows negative or nonspecific findings.

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Author notes

  1. Erina Sugita and Homare Sonoda equally contributed to this work.

Authors and Affiliations

  1. Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Erina Sugita, Homare Sonoda, Masaki Ryuzaki, Takeshi Kanda & Hiroshi Itoh

  2. Department of Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Akinori Hashiguchi

  3. Department of Internal Medicine, Tokyo Dental University Ichikawa General Hospital, 5-11-13 Sugano, Ishikawa-shi, Chiba, 272-8513, Japan

    Hirobumi Tokuyama

  4. Division of Nephrology, Department of Internal Medicine, Tokushima University School of Medicine, 2-50-1 Kuramoto-cho, Tokushima-shi, Tokushima, 770-8503, Japan

    Shu Wakino

Authors
  1. Erina Sugita
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  2. Homare Sonoda
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  3. Masaki Ryuzaki
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  4. Akinori Hashiguchi
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  5. Hirobumi Tokuyama
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  6. Shu Wakino
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  7. Takeshi Kanda
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  8. Hiroshi Itoh
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Correspondence to Takeshi Kanda.

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Sugita, E., Sonoda, H., Ryuzaki, M. et al. Diagnosis of monoclonal immunotactoid glomerulopathy with positive λ chain by immunoelectron microscopy. CEN Case Rep 12, 7–13 (2023). https://doi.org/10.1007/s13730-022-00714-1

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  • DOI: https://doi.org/10.1007/s13730-022-00714-1

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