PMC8560281_01
Clinical course of the patient. THP-COP: combination of pirarubicin, cyclophosphamide, vincristine, and prednisolone, EGD: esophagogastroduodenoscopy, CR: complete response, mPSL: methyl prednisolone pulse therapy, PSL: prednisolone, HD: hemodialysis, LDH: lactate dehydrogenase, Cre: creatinine, and Plt: platelet.
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fig1
Prednisolone was gradually tapered to a dose of 5 mg/day (Figure 1).
(a) Light microscopy of the biopsied sample (Masson's trichrome stain, original magnification x48). (b) Segmental endocapillary hypercellularity (arrow) (periodic acid-silver methenamine stain, original magnification x400). (c) Focal double contours without spike formation (arrows) and mesangiolysis (arrowhead) (periodic acid-silver methenamine stain, original magnification x400). (d) Wrinkling of the glomerular basement membrane (periodic acid-silver methenamine stain, original magnification x400). (e) Segmental thrombus in one glomerulus (arrowhead) (periodic acid-Schiff stain, original magnification x400). Some arterioles revealed thickness of the arterial intima and narrowing or complete obstruction of the vessel lumina. (f) Periodic acid-silver methenamine stain, original magnification x400. (g) Periodic acid-Schiff stain, original magnification x400.
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fig2
On performing light microscopy, we observed the following: the biopsied sample contained 43 glomeruli, of which 8 showed global sclerosis, 1 showed segmental sclerosis, and 1 showed a thrombus (Figure 2(a)). Segmental endocapillary hypercellularity, focal double contours without spike formation, and mesangiolysis were observed (Figures 2(b) and 2(c)). Wrinkling of the glomerular basement membrane (GBM) was also observed (Figure 2(d)). A segmental thrombus was observed in one glomerulus (Figure 2(e)). Tubular atrophy and interstitial fibrosis were noticed (Figure 2(a)). Some arterioles revealed thickness of the arterial intima and narrowing or complete obstruction of the vessel lumina (Figures 2(f) and 2(g)).
Electron microscopy revealed wrinkling of the glomerular basement membrane, expansion of the subendothelial space (asterisks), mesangial interposition (arrowhead), and reduplication of the glomerular basement membrane (arrow) (electron microscopy, original magnification x3000).
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fig3
Electron microscopy revealed wrinkling of the glomerular basement membrane (GBM), expansion of the subendothelial space, mesangial interposition, and reduplication of the GBM (Figure 3).