Figure 1140

Glomerular deposition of immunoglobulin A-X paraproteins. No paraproteins or cryoglobulins could be found in the serum of this patient. In addition, the urinary excretion of light chains was not detectable. A, A mesangiocapillary pattern of injury with deposition of eosinophilic material in the capillary wall and mesangium. B, Immunofluorescence. The deposits were positive for X light chains (and immunoglobulin A). C, Ultrastructurally, below the glomerular basement membrane, organized deposits composed of parallel arranged fibrils or gridlike structures can be seen. (Panel A, methenamine silver, original magnification X400, X400, X 25,000, respectively.)

FIGURE 11-41 (see Color Plate)

Glomerular deposition of immunoglobulin G-X in a patient with multiple myeloma. A, Glomerulus with many intracapil-lary protein thrombi. B, The material was composed of

closely packed tubules arranged in parallel. (Panel A, toluidine blue. Original magnification X600, X 130,000, respectively.)

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