case_images: PMC11821651_01
case_images: Pathological changes in renal biopsy tissue. (A) Light microscopy of a renal biopsy sample: significant widening of the mesangial area in the glomeruli, with increased matrix predominance and focal nodular changes. x400. (B) Electron microscopy findings. Electron-dense deposits were detected along the glomerular basement membrane (arrowhead). (C) Immunohistochemical staining for lambda light chain x200. (D) Immunohistochemical staining for kappa light chain, x200.
case_images: fonc-15-1466323-g001.jpg
case_images: PMC11821651_01_fonc-15-1466323-g001.jpg
case_images: f1
case_images: Renal pathology showed significant widening of the mesangial area in the glomeruli, with increased matrix predominance and focal nodular changes ( Figure 1A ). Immunofluorescence revealed of kappa light chains deposition in the glomeruli, renal tubular basement membranes, and Bowman's capsule wall ( Figures 1C, D ). Electron microscope revealed the deposition of striped electron-dense material on the inner side of the glomerular basement membrane ( Figure 1B ).
case_images: The patient's clinical course during follow-up. (A) Changes in Scr levels. (B) Changes in eGFR. (C) Changes in serum free light chain kappa. (D) Changes in proteinuria. PCD, bortezomib, dexamethasone, and cyclophosphamide; PD, bortezomib and dexamethasone; Dara, daratumumab. Scr, serum creatinine; eGFR, estimated glomerular filtration rate; sFLC, serum free light chain.
case_images: fonc-15-1466323-g002.jpg
case_images: PMC11821651_01_fonc-15-1466323-g002.jpg
case_images: f2
case_images: After discontinuation of treatment for 6 months, a June 2023 follow-up examination revealed the following results: creatinine 186 mumol/L, eGFR 35.5 ml/min/1.73 m2, sFLC kappa 13.2 mg/L, sFLC lambda was 16.0 mg/L, kappa/lambda ratio 0.83, and urine protein 133 mg/24 h ( Figure 2 ).