A large-sized bubbling appearance of the glomerular basement membrane in a patient with pulmonary limited AL amyloidosis and a past history of lupus nephritis

Clin Exp Nephrol. 2011 Dec;15(6):970-5. doi: 10.1007/s10157-011-0528-8. Epub 2011 Aug 30.

Abstract

We report an unusual pathological finding, a large-sized bubbling appearance of the glomerular basement membrane (GBM), in a patient with pulmonary limited AL amyloidosis and a past history of lupus nephritis. The first renal biopsy specimen from 10 years ago, when systemic lupus erythematosus was diagnosed, demonstrated mild mesangial proliferation and subepithelial deposits (WHO classification: III + V). Light microscopy of the current biopsy using periodic acid methenamine silver (PAMS) stain demonstrated a large-sized bubbling appearance of the GBM; however, very weak immunoglobulin and complement deposition was observed in immunofluorescence studies. Routine electron microscopy demonstrated partial subendothelial expansion with electron-lucent materials, but no electron-dense deposits or amyloid fibrils. Electron microscopy with PAMS stain revealed electron-lucent endothelial scalloping, including some cellular components and microspheres in the GBM; however, it is not clear if these materials are derived from endothelial cells. One possibility is that these unique findings represent a recovery phase of lupus membranous nephritis; another is that these findings correspond to a new disease entity.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Amyloidosis / complications*
  • Amyloidosis / diagnostic imaging
  • Amyloidosis / pathology
  • Biopsy
  • Female
  • Fluorescent Antibody Technique
  • Glomerular Basement Membrane / pathology*
  • Glomerular Basement Membrane / ultrastructure
  • Humans
  • Lung Diseases / complications*
  • Lung Diseases / diagnostic imaging
  • Lung Diseases / pathology
  • Lupus Nephritis / complications*
  • Lupus Nephritis / pathology
  • Microscopy, Electron
  • Tomography, X-Ray Computed