Acute cerebral infarction in a patient with nodular glomerulopathy—Atypical features and differential diagnosis

Nodular glomerulopathy is a pattern of glomerular injury observed under light microscopy that could result from several diseases presented as nephrotic syndrome clinically. Compared with venous thrombosis, cerebral infarction resulting from arterial thrombosis is relatively rare in these patients. We report an interesting case of severe nephrotic syndrome complicated with acute cerebral infarction, and renal biopsy revealed nodular glomerulopathy under light microscopy. Immunofluorescent staining was positive for λ light chain (predominant) and κ light chain, mainly in mesangial areas, and electron microscopic study showed massive amorphous acellular deposits also in mesangial areas with some local extension to subendothelial space. Congo red stain gave negative results under polarized light. The case was concluded as an atypical presentation of light chain deposition disease both pathologically and clinically.

摘要結節性腎絲球病變為腎絲球遭受傷害的所表現的一種形態，可能由某些特定疾病所導致，臨床表現為腎病症候群，相較於較常見的靜脈栓塞; 以中風來表現的急性動脈梗塞是相對少見的。我們報告一位嚴重腎病症候群併發急性腦梗塞的病人，腎臟切片結果於光學顯微鏡下顯示為結節性腎絲球病變的型態，螢光染色顯示免疫λ和κ輕鏈陽性反應，而以λ輕鏈為主，主要沉積於腎間質區，電子顯微鏡下顯示大量免疫複合體沉積於腎間質區，部分延伸至腎絲球血管下。剛果紅染色於偏光鏡下為陰性反應，病理上確診為免疫球蛋白輕鏈沉積病變，其沉積型態與以往報告過的不同，於臨床上和病理上皆為較特殊的表現。