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Waldenström’s Macroglobulinemia

Waldenström's Macroglobulinemia, arkana laboratories, teaching points for renal pathology, kidney biopsy
A 57-year-old white male presents with fatigue, mild proteinuria, and a creatinine of 1.5 mg/dL. He was diagnosed with lymphoplasmacytic lymphoma 6 months ago, but refused treatment. Figures 1 & 2 show prominent pseudothrombi and a membranoproliferative pattern of glomerular injury. Image 3 shows moderate interstitial fibrosis. Image 4, 5, 6, & 7 show IgG, IgM, kappa, and lambda, respectively. This is a case of cryoglobulinemic glomerulonephritis secondary to lymphoplasmacytic lymphoma (Waldenström's macroglobulinemia). Waldenström's macroglobulinemia is a rare B-cell lymphoma characterized by lymphoplasmacytic cell infiltration in the bone marrow and other organs and the presence of a monoclonal immunoglobulin M...

Diagnose This! (June 4, 2018)

The patient is a 67 y/o Caucasian female with slowly progressive kidney disease and 2.3 gm/24 hr proteinuria. Aside from hypertension, she has no significant past medical history. Congo red was negative, however, immunofluorescence showed IgG and lambda staining within glomeruli. What is this immunoperoxidase stain? For bonus points, what was found on electron microscopy?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​  ...