of renal insufficiency, nephrotic proteinuria, and nodular
glomerulosclerosis supports both light-chain deposition disease
and light-chain (AL) amyloidosis as the most likely renal lesions.
Light-chain deposition disease is more often associated with kappa light
chains, while amyloidosis is associated with lambda light chains. The
distinguishing feature in this case is the presence of granular deposits
along the basement membranes and in the glomerular nodules on electron
microscopy, which support a diagnosis of light-chain deposition disease.
In contrast, AL amyloidosis is characterized by fibrillar deposits
(8-10 nm in diameter) on electron microscopy. Hypertensive
arteriolonephrosclerosis is extremely unlikely in the presence of
nephrotic proteinuria and the noted histologic findings. Multiple myeloma
cast nephropathy is not complicated by nephrotic proteinuria, and the
classic lesions seen on renal biopsy are fractured proteinacious casts
in the distal tubular lumens, often associated with multinucleated giant cells.
- Light-chain deposition disease in the kidney.
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Hospital Physician Board Review Manuals
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