PMC2724597_01
Kidney biopsy findings. (A) Kidney cortical tissue shows an intact glomerulus, proximal tubules with degenerative changes of the cells, and an increase in number of protein reabsorption granules (arrows), interstitial fibrosis, and mild infiltration of the interstitium by mononuclear inflammatory cells (periodic acid-Schiff). (B) Hematoxylin and eosin stain highlights the eosinophilic characteristics of the protein reabsorption granules (arrows) in proximal tubules. (C) Immunohistochemistry shows strong positive staining of granules in the proximal tubule (immunoperoxidase for lysozyme). (D) Electron microscopy shows an increase in number and size of lysosomes in proximal tubules.
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Tubules showed degenerative changes with loss of brush borders in proximal segments and prominent eosinophilic protein-reabsorption granules (Fig 1A and B). However, proximal tubular cytoplasm was filled with large and prominent lysosomes (Fig 1D).
Line graph shows serum creatinine and urine protein-creatinine ratio values over time. 1 on x-axis represents time of presentation to the kidney clinic.
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Figure 2 shows the trend of serum creatinine levels and proteinuria during the course of management.