PMC5438014_01
Kidney biopsy findings of immune complex-mediated glomerulonephritis and time course of disease. A: A hypercellular glomerulus, interstitial inflammation, and red blood cell casts are seen on intermediate-power light microscopy (PAS stain, 100x). B: Global endocapillary proliferation without crescent formation is seen on high-power light microscopy (PAS stain, 400x). C: Significant reactivity for C3 (the strongest of all components) is seen on direct immunofluorescence microscopy (400x). D: Large sub-endothelial deposits (labeled with arrows) are seen on electron microscopy. E: Time course of the serum creatinine, rheumatoid factor, and complement component C3 and C4 over the duration of the hospitalization.
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Figure1
On hospital day 4, he underwent a percutaneous kidney biopsy, which revealed diffuse proliferative glomerulonephritis with global involvement of glomeruli and evidence of endocapillary and mesangial proliferation (Figure 1A - D). He was discharged on hospital day 27 with a serum creatinine of 2.8 mg/dL (Figure 1E), and 13 months after resolution of the bacterial endocarditis and resolution of the glomerular inflammation, his kidney function had fully normalized, with a return of the serum creatinine to 0.8 mg/dL.