Tubulointerstitial Nephritis Accompanying Gamma-Heavy Chain Deposition and Gamma-Heavy Chain Restricted Plasma Cells in the Kidney

Authors

  • Ali Nayer Division of Nephrology and Hypertension, University of Miami, Miami, FL, USA Author
  • Dollie F Green Division of Nephrology and Hypertension, University of Miami, Miami, FL, USA Author
  • Maria L Gonzalez-Suarez Department of Medicine, University of Miami, Miami, FL, USA Author
  • Victoria Sujoy Hematopathology Laboratory, University of Miami, Miami, FL, USA Author
  • Offiong F Ikpatt Hematopathology Laboratory, University of Miami, Miami, FL, USA Author
  • David B Thomas Renal Pathology Laboratory, University of Miami, Miami, FL, USA Author

Abstract

Monoclonal immunoglobulin heavy chain (HC) diseases are rare proliferative disorders of B lymphocytes or plasma cells characterized by the presence of monoclonal α-, µ-, or γ-HC without associated light chains in the blood, urine, or both. We report a 59-year-old woman with a history of Hodgkin disease who developed hypercalcemia, proteinuria, and impaired kidney function. Protein electrophoresis and immunofixation displayed γ-HC without associated light chains in the serum and urine. Pathologic examination demonstrated severe tubulointerstitial nephritis associated with diffuse and strong linear staining of the glomerular and tubular basement membranes as well as Bowman capsules for γ-HC, but not for κ- or λ-light chains. Immunohistochemical examination of the kidney and bone marrow demonstrated numerous CD138+ plasma cells immunoreactive for γ-HC, but not for κ- or λ-light chains. This is the first report of tubulointerstitial nephritis associated with γ-HC deposition and γ-HC restricted plasma cells in the kidney. This report heightens awareness about tubulointerstitial nephritis as a possible manifestation of γ-HC deposition in the kidney.

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Author Biographies

  • Ali Nayer, Division of Nephrology and Hypertension, University of Miami, Miami, FL, USA

    Associate Professor of Medicine

    University of Miami

    Miami, Florida, USA

  • Dollie F Green, Division of Nephrology and Hypertension, University of Miami, Miami, FL, USA

    Associate Professor of Medicine

    University of Miami

  • Maria L Gonzalez-Suarez, Department of Medicine, University of Miami, Miami, FL, USA

    Department of Medicine

    University of Miami

  • Victoria Sujoy, Hematopathology Laboratory, University of Miami, Miami, FL, USA

    Division of Hematopathology

    Department of Pathology

    University of Miami

  • Offiong F Ikpatt, Hematopathology Laboratory, University of Miami, Miami, FL, USA

    Assistant Professor of Pathology

    Division of Hematopathology

    Department of Pathology

    University of Miami

  • David B Thomas, Renal Pathology Laboratory, University of Miami, Miami, FL, USA

    Division of Nephropathology

    Department of Pathology

    University of Miami

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Published

2014-06-21

Issue

Section

CASE REPORT | Kidney Diseases

How to Cite

Tubulointerstitial Nephritis Accompanying Gamma-Heavy Chain Deposition and Gamma-Heavy Chain Restricted Plasma Cells in the Kidney. (2014). Iranian Journal of Kidney Diseases, 8(5), 417-423. https://www.ijkd.org/index.php/ijkd/article/view/1370

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