关键词: 增生性肾小球肾炎伴单克隆IgG沉积, 巨噬细胞, 结晶, 内含物

Abstract: A 68yearold man presented as nephrotic syndrome,hematuria,hypertension,anemia,and monoclonal IgGκ in serum immunofixation electrophoresis (IFE).Renal biopsy revealed membranoproliferative glomerulonephritis (MPGN),with IgG3κ staining in glomeruli and nonorganized electrondense deposition in the mesangium and subendothelial area.In addition,CD68+ macrophages with eosinophilic droplets or globules in cytoplasm within segmental capillary loops were κ light chain positive on immunofluorescence.Electron microscopy showed intracytoplasmic crystalloid inclusions within macrophages and mesangial cells.The final diagnosis was proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) with glomerular intracellular crystalloid inclusions.He was treated with bortezomib and dexamethasone,and achieved a partial responseAfter 8 months,arepeated renal biopsy demonstrated that active glomerular proliferation reversed.And IgG,κ light chain and crystalloid inclusions were almost disappeared.