Brealey John K, Tran Yung, Ninnes Ruth, Abeyaratne Asanga
a Division of Anatomical Pathology , SA Pathology , Adelaide , Australia.
b Renal Unit , Royal Darwin Hospital , Darwin , Australia.
Ultrastruct Pathol. 2018 Sep-Oct;42(5):458-463. doi: 10.1080/01913123.2018.1526243. Epub 2018 Sep 25.
A multiple myeloma patient, who had been treated with a hematopoietic stem cell transplant, underwent a renal biopsy for investigation of a possible relapse of disease as indicated by increased serum creatinine and positive urinary Bence-Jones protein containing increased kappa light chain. Paraprotein-related renal disease was not evident by light microscopy or immunofluorescence microscopy however electron microscopy demonstrated a proximal tubulopathy with intracytoplasmic non-crystalline inclusions. The ultrastructural findings suggested possible end-organ involvement by the disease and follow-up studies subsequently revealed a relapsed multiple myeloma in the patient. The case exemplifies the usefulness of electron microscopy in detecting paraproteins that, in some instances, may be difficult to demonstrate by other techniques.
一名接受过造血干细胞移植治疗的多发性骨髓瘤患者，因血清肌酐升高及尿本-周蛋白阳性（含κ轻链增加）提示可能疾病复发而接受肾活检。光镜或免疫荧光显微镜检查未发现副蛋白相关肾病，但电镜显示近端肾小管病伴胞质内非结晶性包涵体。超微结构发现提示疾病可能累及终末器官，随后的随访研究显示该患者多发性骨髓瘤复发。该病例证明了电镜在检测副蛋白方面的有用性，在某些情况下，其他技术可能难以检测到这些副蛋白。
