PMC6375021_01
(a) Low magnification photomicrograph showing myeloma casts, focal acute tubular injury, and the presence fine vacuoles in the tubular epithelium (representing tubulopathy). No crystalline inclusions seen (H and E, x100). (b) Myeloma cast surrounded by giant cell (PAS, x400)
IJN-29-65-g001.jpg
PMC6375021_01_IJN-29-65-g001.jpg
F1
We advised for a repeat graft biopsy, which showed evidence of MCN [Figure 1] with lambda (lambda) light chain restriction [Figure 2] and proximal tubulopathy [Figure 3].
Direct immunofluorescence showing lambda restricted cast nephropathy (a: Anti-lambda, b: Anti-kappa, FITC tagged)
IJN-29-65-g002.jpg
PMC6375021_01_IJN-29-65-g002.jpg
F2
We advised for a repeat graft biopsy, which showed evidence of MCN [Figure 1] with lambda (lambda) light chain restriction [Figure 2] and proximal tubulopathy [Figure 3].
Direct immunofluorescence showing lambda restricted proximal tubulopathy (a: Anti-lambda, b: Anti-kappa, FITC tagged)
IJN-29-65-g003.jpg
PMC6375021_01_IJN-29-65-g003.jpg
F3
We advised for a repeat graft biopsy, which showed evidence of MCN [Figure 1] with lambda (lambda) light chain restriction [Figure 2] and proximal tubulopathy [Figure 3].