PMC10152566_01
Clinical course. SBP = systolic blood pressure; DBP = diastolic blood pressure; sCr = serum creatinine; Plt = platelet count; LD = lactate dehydrogenase.
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Figure1
TMA with mHTN. The continuous intravenous infusion of nicardipine was started as initial therapy for severe hypertension (Figure 1).
Renal biopsy findings. A: Ischemic glomeruli and global sclerotic glomeruli (arrow) were observed, and tubular atrophy and interstitial fibrosis were detected in 30% of the area (periodic acid methenamine staining, original magnification x 40). B: A globally sclerotic glomerulus shown in (A) indicated by an arrow (periodic acid methenamine staining, original magnification x 400). C, D: In glomeruli, there were mild ischemic changes, but no thrombi (C: periodic acid-Schiff staining, original magnification x 400, D: periodic acid methenamine staining, original magnification x 400). E, F: An interlobular artery exhibited "onion skin" with a narrowing lumen (E: periodic acid-Schiff staining, original magnification x 100, F: Elastica-Masson staining, original magnification x 100). G, H: There were no deposits of IgG (G) or C3 (H) on direct immunofluorescence microscopy (original magnification x 200). I: Slight subendothelial edema (arrowheads) was observed on electron microscopy (original magnification x 18,000).
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Figure2
Although there were no apparent thrombi in glomeruli, ischemic changes were observed (Figure 2A - D), which were presumably associated with arteriolar narrowing due to intimal thickening (Figure 2E, F). Tubular atrophy and interstitial fibrosis were observed in 30% of the area (Figure 2A). Direct immunofluorescence microscopy showed no deposits of immunoglobulins or complements (C3 and C4) (Figure 2G, H). Slight subendothelial edema was detected on electron microscopy (Figure 2I).