Morphologic variants of light-chain deposition disease in the kidney.

A variety of histologic changes have been observed in the kidneys of patients with light-chain deposition disease. We report 3 cases with kappa light chain deposition who presented with diverse clinical, histological, and ultrastructural features. All the cases were diagnosed by the presence of monoclonal kappa light chain deposits by immunohistochemical methods. Based on the present study and review of literature, four basic patterns of glomerular lesions are identified: (1) minimal glomerular changes without glomerular deposits, but with extensive tubular involvement; (2) mild glomerular changes with glomerular deposits; (3) focal or diffuse proliferative glomerulonephritis with or without crescents, and (4) nodular glomerulosclerosis resembling diabetic glomerulosclerosis. This pathological and clinical variability can cause diagnostic problems at initial presentation. A high index of suspicion is necessary along with appropriate laboratory data and routine staining for light chains.

Acute tubulo-interstitial nephritis from candida albicans with oliguric renal failure.

A patient developed candidemia after receiving steroids and antibiotics. Subsequently, acute oliguric renal failure occurred. Renal biopsy showed multiple cortical microabscesses. These contained encapsulated ovoid Candida, budding organisms, short hyphae, and polymorphs. Adjacent tubules showed disruption of the basement membrane, infiltration by polymorphs and necrosis. There was no evidence of pelvic-calyceal obstruction by bezoar. The acute renal failure was attributed to acute candidal tubulo-interstitial nephritis, and was successfully reversed with Amphotericin.

Tubular microfibrils in the glomeruli of membranous nephropathy.

The presence of tubular microfibrils in the mesangium and capillary walls of the renal glomeruli is a rare occurrence that has been reported by others in different glomerular disease processes. The two cases presented in this report demonstrated such microfibrils in membranous glomerulonephropathy, an association previously described in only one other case. These microfibrils differed in size and structural characteristics from collagen fibers, amyloid fibrils, and cryoglobulin microtubules.

Nephrotic syndrome associated with use of the nonsteroidal anti-inflammatory drugs. Case report and review of the literature.

Although acute interstitial nephritis associated with the use of nonsteroidal anti-inflammatory drugs has long been recognized, only recently has its association with 'minimal change' nephrotic syndrome been reported. We report here a case of this pattern of nephrotic syndrome without concurrent interstitial nephritis associated with the use of tolmetin. The clinical picture, laboratory data, course, and relevant histopathologic findings of previous cases in the literature of nephrotic syndrome related to the use of the nonsteroidal anti-inflammatory drugs are reviewed and discussed.

Concomitant presence of three different glomerular diseases in the same patient. Report of a case and review of the literature.

A 51-year-old man with diabetes mellitus and the nephrotic syndrome on renal biopsy was found to have diabetic glomerulosclerosis, amyloidosis and membranous glomerulopathy. The presence of three distinct glomerular diseases in the same patient is unique. Possible factors involved in their pathogenesis are discussed and the literature on concomitant glomerular diseases is reviewed.

Role of electronmicroscopy in the classification of lupus nephritis.

The role of transmission electronmicroscopy in the clarification of the pleomorphic lesions of lupus nephritis is reviewed. Emphasis is placed on the WHO classification of glomerular lesions and in the importance of electronmicroscopy, particularly the precise identification of the milder forms of glomerular involvement. This is essential for the proper therapeutic management of patients with lupus nephritis and to establish a more accurate prognosis.