PMC9869233_01
(A) Hematoxylin and eosin stain on light microscopy:Segmental necrotizing crescentic lesion (Asterisk). (B) Silver stain on light microscopy:Cellular crescent with fibrinoid necrosis (Arrow) and break in the glomerular basement membrane. (C) Trichrome stain showing 55% to 60% Interstitial Fibrosis and Tubular Atrophy. (D) Electron microscopy show glomerular basement membrane within normal limits without any electron dense deposits. Partial foot process effacement (25%-50%). No mesangial expansion or deposits with normal endothelium and patent capillary lumen.
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This revealed a pauci-immune necrotizing glomerulonephritis, with 14 of 16 glomeruli globally sclerotic, and 2 glomeruli with active segmental necrotizing lesions with fibrinoid necrosis and karyorrhectic debris (Figure 1A and 1B) and, there was evidence of acute tubular injury. Trichrome stain (Figure 1C) showed around 50% to 60% interstitial fibrosis and tubular atrophy (IFTA) alluding to the chronicity of the underlying process. There were no immune-complex deposits on electron micoscopy either (Figure 1D).