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Glomerular deposition of monoclonal IgM, frequently in the form of intracapillary pseudothrombi, can be seen in Waldenström macroglobulinemia (WM) and type I cryoglobulinemia (CG). They are typically associated with plasma cell or B-lymphoid neoplasms, particularly lymphoplasmacytic lymphoma (LPL). While infection is a frequent trigger of mixed (type II and III) CG, its association with type I CG is uncommon. We report two cases in which striking lambda-chain-restricted IgM deposits and acute kidney injury (AKI) occurred in the setting of known or suspected systemic infections, with prompt resolution on treatment of the infection. [ABSTRACT FROM AUTHOR]

Electron microscopy is a mainstay in the analysis of renal biopsies, where it is typically employed in a correlative fashion along with light and immunofluorescence microscopy. Despite the development of a growing armamentarium of molecular and biochemical analytic methods as well as new immunostains with a widening panel of immunoreactants, electron microscopy remains crucial to the diagnosis of a number of disorders involving the renal glomerulus, vasculature, and tubulointerstitial compartment. The number of renal biopsies continues to grow and the indications for these biopsies continue expanding together with our understanding of disease processes. Proper collection of biopsies and careful analysis of data emanating from diagnostic modalities, clinical information, imaging, gross and microscopic tissue analysis, including a wide range of ancillary studies, represent the essential paradigm for generating detailed diagnoses with clinical significance. This communication offers a guide to the pre-analytic and analytic process for renal biopsy examination, discusses diagnostic keys and pitfalls for an important category of renal diseases (immune complex disorders), and provides an introduction to a useful adjunct diagnostic method (ultrastructural immunolabeling). Renal pathologists should render expert diagnoses that guide patient management, provide prognostic information and lead to targeted new therapeutic interventions that are currently available. [ABSTRACT FROM AUTHOR]

Organized or structured deposits are encountered during electron microscopic examination of kidney tissue in a wide variety of primary renal and multisystemic disorders. They are most commonly seen in the renal glomerulus, though extraglomerular sites are occasionally involved. In some cases, organized deposits herald the presence of a specific disease process. Included in this category are organized substances containing immunoglobin molecules or parts thereof as well as non-immunoglobin-containing materials that accumulate in several rare heritable disorders. A second broad category of structured deposits include substances that accumulate in response to non-specific tissue injuries. In many instances, such "look-alikes" can be difficult o distinguish from disease-specific structured deposits. Ultrastructural pathology is central to the detection and characterization of organized deposits in the kidney and is the primary focus of this paper. Correlative light microscopic studies are often useful, however, and will be described as well.. [ABSTRACT FROM AUTHOR]