PMC6719466_01
Imaging studies: (a) chest x-ray anteroposterior view, (b) chest x-ray lateral view, (c) chest CT scan coronal section and (d) chest CT scan sagittal section.
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Chest x-ray showed vague pulmonary infiltrates, and the patient tested negative for tuberculosis (Figure 1). CT chest showed pulmonary parenchymal findings in keeping with an infectious process (Figure 1).
Laboratory changes in renal function.. eGFR: estimated glomerular filtration rate.
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The kidney function was normal at presentation and remained stable (within the normal range) throughout the follow-up period (Figure 2). Urinalysis showed 1+ haemoglobin and trace protein, and urine protein: creatinine ratio of 36.9 mg/mmol (Normal < 13 mg/mmol) (Figure 2).
Kidney biopsy: light microscopy - (a) PAS staining and (b) H&E - the glomerulus exhibits a cellular crescent with focal breach in the Bowman's capsule; no fibrinoid necrosis is seen; there were 11 glomeruli in the representative section, two contain segmental proliferative foci and remaining glomeruli show no conspicuous changes; mild intestinal edema and patchy mild interstitial fibrosis and tubular atrophy without segmental interstitial fibrosis; and vessels show no conspicuous changes. (c) Electron microscopy (EM) - the EM photomicrograph shows mild effacement of podocyte foot processes and a near break in the capillary basement membrane which is the cause of crescent; no immune complex deposition; and peritubular capillaries have normal structure.
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Based on the previous features of a systemic illness and new findings on urinalysis and urine microscopy, the patient underwent a kidney biopsy, and the tissue was analysed and reported by our pathology service (Figure 3).