PMC4753741_01
(a) The core biopsy with half of the cortex showing acute cortical necrosis (arrow) (PAS, x40). (b) Illustrates the thrombotic microangiopathy in one of the vessels with total occlusion of the lumen (arrow) (PAS, x400)
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F1
Light microscopy revealed evidence of ACN in the form of infarcted glomeruli with severe loss of cellular details of proximal tubular cells and extensive areas of hemorrhage involving 25% of the biopsied area [Figure 1a] and also there was an evidence of TMA in the form of fibrinoid necrosis of one of the arteries with near total occlusion of the lumen [Figure 1b].
(a) Mesangial expansion and mild mesangial cellularity (H and E, x400). (b) Direct immunofluorescence reveals granular positivity in the mesangium with immunoglobulin A (3+)
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F2
Glomeruli from the viable area showed mesangial expansion with increase in cellularity [Figure 2a]. Direct immunofluorescence showed the deposition of IgA (3+), C3 (2+), and lambda (3+) in the mesangium and focally along glomerular capillary wall [Figure 2b].