Light Chain Deposition Disease Recurrence in Renal Allograft after Long-Term Remission.

Light chain deposition disease (LCDD) is a rare manifestation of monoclonal gammopathy, which can lead to renal failure. We previously reported a detailed recurrence process in a case of LCDD after renal transplantation. To the best of our knowledge, no report has described the long-term clinical course and renal pathology findings of recurrent LCDD in patients after renal transplantation. In this case report, we describe the long-term clinical presentation and changes in renal pathology of the same patient after early LCDD relapse in a renal allograft. A 54-year-old woman with recurrent immunoglobulin A λ-type LCDD in an allograft was admitted 1 year post-transplant for bortezomib and dexamethasone therapy. At 2 years post-transplantation, a graft biopsy performed after complete remission was achieved, showing some glomeruli with residual nodular lesions similar to the pre-treatment renal biopsy findings. However, the enlarged subendothelial space disappeared. She remained in complete remission serologically for 6 years. Subsequently, the ratio of serum κ/λ-free light chains decreased gradually. She underwent a transplant biopsy approximately 12 years after renal transplantation due to increased proteinuria and decreased renal function. Compared with the previous graft biopsy, almost all glomeruli showed advanced nodule formation and subendothelial expansion. Because the LCDD case relapsed after long-term remission following renal transplantation, protocol biopsy monitoring might be necessary.

Triglyceride metabolism in Japanese kidney transplant recipients.

BACKGROUND: Residual cardiovascular risk factors, such as triglyceride (TG), can cause cardiovascular disease. The role of TG metabolism in kidney transplantation remains unclear. METHODS: Sixty-three consecutive stable recipients at 1 year after their kidney transplants were included in the study from January to September 2014 at Nagoya Daini Red Cross Hospital. We performed the cookie test to evaluate TG metabolism. TG, blood sugar, and remnant-like particle cholesterol (RLP-C) were measured at fasting (f) and 2 and 4 h after ingestion. Low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively) and apoB levels were measured at fasting. RESULTS: Mean TGf and RLP-Cf were 139.4 ± 62.6 and 5.6 ± 3.4 mg/dl, respectively, and were within normal ranges; however, both mean TG 2 and 4 h were >200 mg/dl, and both mean RLP-C 2 and 4 h were >9 mg/dl. A negative correlation was seen between TGf and eGFR (r = -0.48, p < 0.001). TGf positively correlated with RLP-C, non-HDL-C, LDL-C/apoB ratio, and body mass index (r = 0.80, p < 0.001; r = 0.47, p < 0.001; r = 0.48, p < 0.001; and r = 0.38, p = 0.002, respectively). LDL-C levels were controlled because of the use of statin, but LDL-C/apoB ratio levels in 50% of the recipients were <1.2, indicating that the rate of small dense LDL-C in LDL-C had increased. CONCLUSION: The prevalence of postprandial hypertriglyceridemia among kidney transplant recipients was high; however, the question of whether or not it should be treated remains unknown.