Polyclonal immunoglobulin G deposition on the tubular basement membrane in a diabetic nephropathy: A case report

Hirofumi Watanabe, Yoichi Takeuchi, Shinji Taniuchi, Hiroshi Sato, Yasuhiro Nakamura, Hironobu Sasano, Kensuke Joh

Research output: Contribution to journalArticlepeer-review

Abstract

A 70-year-old Japanese man with diabetes mellitus was referred to our hospital for treatment of renal dysfunction. Renal biopsy revealed that the tubular basement membrane (TBM) showed extreme thickening histologically, and selective polyclonal immunoglobulin G deposition on the thickened TBM, whereas no immunoglobulin deposition was found in the glomeruli in an immunofluorescence study. In electron microscopy, a powdery type of electron dense material, which was similar to that seen in Randall-type monoclonal immunoglobulin deposition disease (MIDD), was observed on the tubular epithelial side of the TBM. However, the present case was differentiated from MIDD, because polyclonal deposition with both kappa and lambda deposition on the TBM was observed. Moreover, there was no noticeable glomerular deposition, which is usually found in cases of MIDD. Anti-TBM disease was also considered as a differential diagnosis, in which polyclonal immunoglobulin deposits selectively on the TBM. However, in the present case, prominent interstitial nephritis was not observed. A similar case with a history of diabetes mellitus has been reported, which was diagnosed as Polyclonal Immunoglobulin G Deposition Disease. No further reports of this case have emerged thereafter; we present this case as the second report supporting this article.

Original languageEnglish
Pages (from-to)463-469
Number of pages7
JournalPathology international
Volume70
Issue number7
DOIs
Publication statusPublished - 2020 Jul 1

Keywords

  • diabetic nephropathy
  • polyclonal immunoglobulin deposition disease
  • tubular basement membrane

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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