case_images: PMC6737722_01
case_images: Histopathology seen on renal biopsy.. Light microscopy - The non-sclerotic glomeruli show nodular glomerulosclerosis. The nodules are Periodic acid-Schiff (PAS) (a) and silver positive (b). Numerous periodic acid-Schiff-negative fuchsinophilic casts are present within the tubular lumens, some of which have a cracked appearance and associated inflammation (c). The cortical tubulointerstitial tissue has moderate interstitial edema (d). Immunofluorescence - Frozen sections of tissue submitted show no glomeruli. On a scale of 0-3+, tubular casts stain with kappa light chain (3+, focal) (e) and lambda light chain (1+, focal) (f). Tubular basement membranes stain with kappa light chain (2+) (e) and are negative for lambda light chain (f). Electron microscopy - The two glomeruli evaluated show punctate granular subendothelial electron-dense deposits that have a linear distribution throughout the glomerular basement membranes (g). The tubular basement membranes show similar powdery granular electron-dense deposits (h).
case_images: ZJCH_A_1624136_F0001_OC.jpg
case_images: PMC6737722_01_ZJCH_A_1624136_F0001_OC.jpg
case_images: F0001
case_images: Renal biopsy was consistent with the diagnosis of kappa-LCDD, CN and focal global glomerulosclerosis (3/19, 16%) (Figure 1).