What’s your diagnosis?
These photomicrographs show rhomboid-shaped crystals within proximal tubular cytoplasm on EM and Toluidine blue stain. Although not shown, these crystals showed intense lambda light stain restriction on immunofluorescence confirming a crystalline-type light chain proximal tubulopathy. And, in this patient with Fanconi syndrome and a lambda light chain restricted MGUS, these findings fit within the spectrum of monoclonal gammopathy of renal significance.
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