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51岁男性,病程1月,以高血压起病,肾脏损害主要表现大量蛋白尿,低白蛋白血症,伴少量镜下血尿,肾功能异常。肾外表现有轻度正细胞正色素性贫血,血清免疫固定电泳提示κ型IgG单克隆免疫球蛋白条带,骨髓活检和骨髓细胞学检查均阴性。肾活检组织学改变为肾小球系膜细胞、内皮细胞增生,毛细血管袢内较多CD68+细胞浸润,肾小球基膜内皮下大量、少量系膜区、偶见上皮侧嗜复红物沉积,沉积物免疫荧光染色仅IgG1和κ轻链阳性,电镜观察沉积物具有晶格状结构,免疫电镜证实这些晶格状的物质IgG和κ轻链阳性。该患者最终诊断为增生性肾小球肾炎伴具有晶格状结构的单克隆IgG沉积。
51-year-old man, duration of January, with hypertension, kidney damage mainly shows a large number of proteinuria, hypoalbuminemia, with a small amount of microscopic hematuria, renal dysfunction. Renal manifestations of mild positive cell anemia, serum immunostaining electrophoresis prompted kappa IgG monoclonal immunoglobulin bands, bone marrow biopsy and bone marrow cytology were negative. Renal biopsy histological changes to mesangial cells, endothelial cell proliferation, capillary loop more CD68 + cell infiltration, glomerular basement membrane subcutaneous large, a small amount of mesangial area, occasionally epithelial side of the red blood sediment deposition The immunofluorescent staining of the sediment was positive only for IgG1 and kappa light chain, and the lattice structure was observed by electron microscopy. Immunoglobulin was confirmed by immunoelectron microscopy to be positive for IgG and kappa light chain. The patient eventually diagnosed as proliferative glomerulonephritis with monoclonal IgG deposition with a lattice-like structure.