Which histologic findings are characteristic of light-chain deposition disease (LCDD)?
-
Which histologic findings are characteristic of light-chain deposition disease (LCDD)?
-
@vetri The most characteristic histologic lesion of LCDD is nodular glomerulosclerosis (see the first image shown below) that is virtually indistinguishable from diabetic glomerulosclerosis when using light microscopy. Routine immunofluorescence findings are negative because the antibodies used to identify the immunoglobulins are directed at the heavy chains of immunoglobulins. Therefore, as the name suggests, special stains for light chains must be used to identify this using electron microscopy. Dense granular deposits on the endothelial side of the glomerular basement membrane, on the outer aspect of the tubular basement membrane, or on both may be seen with electron microscopy in persons with LCDD. Classic ultrastructure examination findings include amorphous, noncongophilic, and nonfibrillar deposits. Most of these deposits are of kappa light chains (see the fourth image shown below). At times, the histologic changes are minimal, and occasionally glomeruli may have mesangial deposits. Rarely, glomerular crescents can also be seen in patients with LCDD.