PMC5830812_01
Glomerulus showing increased cellularity, eosinophilic deposits, and thickened basement membrane (H and E, x450)
IJN-28-65-g002.jpg
PMC5830812_01_IJN-28-65-g002.jpg
F1
Widespread flattened tubular epithelium with loss of brush border and a diffuse mononuclear infiltrate in the interstitium were seen [Figures 1-4].
Marked increase in mesangial cells and a few polymorphonuclear leukocytes (H and E, x450)
IJN-28-65-g003.jpg
PMC5830812_01_IJN-28-65-g003.jpg
F2
Widespread flattened tubular epithelium with loss of brush border and a diffuse mononuclear infiltrate in the interstitium were seen [Figures 1-4].
Intracapillary homogeneous eosinophilic pseudothrombi composed of cryoglobulins (H and E, x450)
IJN-28-65-g004.jpg
PMC5830812_01_IJN-28-65-g004.jpg
F3
Widespread flattened tubular epithelium with loss of brush border and a diffuse mononuclear infiltrate in the interstitium were seen [Figures 1-4].
Cryoglobulin pseudothrombi and double contouring of basement membrane (Jones silver, x450)
IJN-28-65-g005.jpg
PMC5830812_01_IJN-28-65-g005.jpg
F4
Widespread flattened tubular epithelium with loss of brush border and a diffuse mononuclear infiltrate in the interstitium were seen [Figures 1-4].
Protein electrophoresis. A sharp monoclonal band is seen (arrow), which has been replaced with a polyclonal pattern after 14 months of treatment
IJN-28-65-g006.jpg
PMC5830812_01_IJN-28-65-g006.jpg
F5
As the above findings suggested a cryoglobulinemic glomerulonephritis with monoclonal light chains, the serum-free light chains, protein electrophoresis, and cryoglobulins were determined as shown in Table 1 and Figure 5a. In December 2014, a repeat serum protein electrophoresis study showed a disappearance of the monoclonal b and [Figure 5b] and a reduction in the kappa light chains to 4.71 ng/ml with a normal ratio of 1.8:1.