A 57-year-old Negro female patient is described with adult Fanconi syndrome, and marked x-light chain proteinuria over a 10-year period, without evidence of multiple myeloma. At necropsy, an unusual nodular form of amyloidosis was found. An antiserum to the x-chain was produced with a unique affinity for the glomerular amyloid of another patient with IgG-x myeloma. The urinary x-chain from both patients had an idiotypic antigenic site. The implications of these findings in relation to the pathogenesis of amyloid is discussed.
Proteinuria was studied in ten renal allograft recipients; it was defined as: (a) glomerular – characterized by predominant albumin excretion; (b) tubular – significant excretion of both albumin and low molecular weight (LMW) proteins; and (c) glomerulo-tubular or mixed type, a combination of the two. LMW protein and albumin were quantitated by polyacrylamide gel electrophoresis with sodium dodecyl sulfate. In the immediate posttransplant period, LMW protein and albumin excretion, expressed as a percentage of creatinine clearance, were high, revealing a mixed pattern, and excretion of both protein classes was higher than during both acute tubular necrosis and acute rejection crisis. Tubular proteinuria was observed in acute tubular necrosis; a glomerulo-tubular or mixed pattern of protein excretion in acute rejection crises.
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