Renal biopsies and autopsy specimens of 23 patients with light chain d
eposition disease (LCDD) and one with only heavy chain deposits, were
studied by light (LM) and electron microscopy (EM) as well as immunohi
stology (IH). Thirteen patients had multiple myeloma; 1 had lymphoma,
and 1 chronic myeloid leukaemia with polycythaemia vera. In nine patie
nts, no lymphoproliferative disease was identified. The LM lesions mos
t suggestive of LCDD, nodular glomerulosclerosis (NS) and thickening a
nd wrinkling of the tubular basement membranes (TBM), were present in
only ten and 13 patients, respectively. In five of seven specimens wit
hout NS or TBM thickening by LM, EM was negative, indicating a limited
value of EM in confirming the diagnosis. Renal amyloidosis was not id
entified, but in one patient amyloid in the heart and tongue was seen
at autopsy. One patient had both granular and extensive glomerular non
-amyloid fibrillary deposits. In two patients myeloma casts were ident
ified. Twenty-one patients showed renal LC immune reactivity, 1 had bo
th alpha heavy and lambda LC, 1 had only detectable gamma heavy chain.
One biopsy was negative by IH, but had characteristic electron dense
deposits. In six patients with immune reactivity to LC, no electron de
nse deposits could be identified by EM. This study emphasizes the spec
trum of renal changes by LM and EM in LCDD, the frequent lack of consi
stency between deposits detected by IH and EM and the difficulty in co
ming to a definite diagnosis without LM, EM and IH. The results of thi
s study and examination of the literature indicates that extensive mor
phological changes are more often present in kappa than in lambda LCDD
.