A case of recurrent light chain deposition disease after living-related renal transplantation - detailed process of the recurrence

A 53-yr-old woman with end-stage renal disease was admitted for renal transplantation (RTX). About a decade ago, she had presented with urinary abnormalities. Monoclonal IgA lambda was detected. Renal biopsy showed nodular glomerulosclerosis, and an immunohistochemical study for lambda was negative. Fibrillary glomerulonephritis was suggested as the most likely diagnosis. RTX was successfully performed, and graft function was stable for the first half year. Graft biopsy was performed at one yr post-transplant. Glomeruli showed nodular lesion similar to native kidney biopsy findings. Immunofluorescence microscopy (IF) indicated strong lambda staining along the glomerular basement membrane, the tubular basement membrane (TBM), and the peritubular capillary. The diagnosis of recurrent light chain deposition disease (LCDD) was confirmed. A series of biopsies are available to conduct studies on the recurrent process of LCDD. Light microscopy showed no remarkable changes up to six months post-RTX. However, the IF study revealed evident granular depositions of lambda along the TBM only at the one-h biopsy. Typical IF staining pattern of lambda and EDD compatible with LCDD were noted after six months post-transplant. This is the first case report that elucidated the details of the recurrent process of LCDD at one yr after the operation.