A little easy because on Immunofluorescence picture 2 is written lambda: in this studying marro is mandatory
Thanks

Dr Mahmoud

Yes, I agree. In this case bone marrow is mandatory

Good cases. I would recommend a brief explanation at the end of the quiz of all the answers for our junior residents

I also agree with this suggestion. In fact, the other way round may be more interesting. The juniors should comment on these and finally the case provider should sum up and bring forth important points for the diagnosis. This will generate interest in the junior residents.

Paediatric nephrologists actually dont see these conditions

Dear colleague
Why you didnt attach the Light microscopy of biopsy as its a first approach to any nephrotic cases.
Regards
Jamshid Roozbeh
Professor of nephrology,Shiraz Iran

hi dear dr . thanx for case presentation.Good luck and I hope you also to introduce another interesting case....

Please avoid abreviations. It's a international forum.
Thanks a lot.

Hi! That is quite good case in term of bright illustration of clinical settings and EM-pattern for LCDD. At the same time IF is not representable and doesn't show light chain restriction. I'd prefer to look at PAS stain for complete explanation of clinical data namely nephrotic range proteinuria. I wonder if there is nodular glomerulopathy or secondary segmental glomerulosclerosis. Presented IF and EM both show only tubular changes.

the EM shows tubular electron dense deposits in the subendothelial location. the IF shows linear kappa light chain deposition on tubular epithelium which is negative for lambda, so this a case of monoclonal deposition disease, light chain type...
nice case