Two types of glomerular lesion in non-amyloid immunoglobulin deposition disease: a case report of IgD-lambda myeloma.

A 60-year-old man with nephrotic syndrome and renal failure was found to have a IgD-lambda myeloma. Autopsy revealed advanced nodular glomerulopathy with codeposition of delta heavy and lambda light chains. Glomerular nodules were of two types: One (type I lesion) is caused by nodular expansion of the mesangium by deposition of abnormal immunoglobulin. The second type (type II lesion) is peripherally lamellated and is ascribed to repeated local mesangiolysis superimposed upon type I lesion. These type I and type II lesions correspond to the two types of nodules in diabetic glomerulosclerosis.