IgD heavy-chain deposition disease: Detection by laser microdissection and mass spectrometry

Virginie Royal, Patrick Quint, Martine Leblanc, Richard LeBlanc, Garrett F. Duncanson, Robert L. Perrizo, Fernando C. Fervenza, Paul Kurtin, Sanjeev Sethi

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Monoclonal Ig deposition disease (MIDD) is a rare complication of monoclonal gammopathy characterized by deposition of monoclonal Ig light chains and/or heavy chains along the glomerular and tubular basement membranes. Here, we describe a unique case of IgD deposition disease. IgD deposition is difficult to diagnose, because routine immunofluorescence does not detect IgD. A 77-year-old man presented with proteinuria and renal failure, and kidney biopsy analysis showed a nodular sclerosing GN with extensive focal global glomerulosclerosis, tubular atrophy, and interstitial fibrosis. Immunofluorescence was negative for Ig deposits, although electron microscopy showed deposits in the glomeruli and along tubular basement membranes. Laser microdissection of glomeruli and mass spectrometry of extracted peptides showed a large spectra number for IgD, and immunohistochemistry showed intense glomerular and tubular staining for IgD. Together, these findings are consistent with IgD deposition disease. Bone marrow biopsy analysis showed 5% plasma cells, which stained for IgD. The patient was treated with bortezomib and dexamethasone, which resulted in improvement of hematologic parameters but no improvement of renal function. The diagnosis of IgD deposition disease underscores the value of laser microdissection and mass spectrometry in further evaluating renal biopsies when routine assessment fails to reach an accurate diagnosis.

Original languageEnglish (US)
Pages (from-to)784-790
Number of pages7
JournalJournal of the American Society of Nephrology
Volume26
Issue number4
DOIs
StatePublished - Apr 1 2015

ASJC Scopus subject areas

  • Nephrology

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