Pathologic Findings Light Microscopy

Light chain deposit disease can have many of the light microscopic morphologic features of diabetic nephropathy, especially because of the nodular glomerular lesions and capillary microaneurysms (2,3,9,10).

The light microscopic appearance of glomeruli was initially emphasized as a nodular glomerulopathy with features virtually indistinguishable from nodular diabetic glomerulosclerosis (Fig. 17.1); however, it has become apparent that there is a large spectrum of glomerular morphologies including normal glomeruli, diffuse widening of mesangium, crescents, etc. The tubular basement membrane deposits often result in the light microscopic appreciation of thickened tubular basement membranes. Careful high magnification examination of periodic acid-Schiff (PAS) -stained sections may indicate a slightly lighter staining band external to the normal basement membrane (1).

Heavy chain deposition disease is characterized by the nonimmunologic binding of an abnormal heavy chain, most commonly immunoglobulin G (IgG), to all basement membranes (8,10). The morphologic aspects differ from light chain deposit disease in that the glomerular structure is almost always nodular. However, glomerular hypercellularity mimicking membra-noproliferative or other proliferative glomerulonephritis may be the dominant morphology (11,12).

Figure 17.1. Light chain deposition disease with glomerulus with nodular mesan-gium. This appearance is similar to diabetic nodular glomerulosclerosis (Jones silver stain).
Figure 17.2. Light chain deposition disease with linear staining of all renal basement membranes and mesangial regions of the glomeruli (kappa immunofluorescence).
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