PMC2636832_01
Therapy scheme and resultant changes in hematocrit (A) and creatinine levels (B) of the patient. Hemodialysis and erythropoietin treatments were initiated on Day one of hospitalization. Prednisone therapy was initiated on Day eight. The hematocrit percentages and creatinine levels were measured at the indicated days. The changes in hematocrit and creatinine levels correlated well with the progression of renal function.
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F1
Emergent hemodialysis was initiated (Figure 1). The patient's hematocrit level continued to drop during the first week of hospitalization, reaching a nadir of 23.6 mg/dl and requiring packed red blood cell transfusion on two occasions (Figure 1A). Prednisone 60 mg/day was initiated (Figure 1).
Histopathologic examination of renal biopsy from the patient. (A) Light microscopy: image showing proximal tubules with marked cytoplasmic swelling and vacuolization. (B) Electron microscopy: image showing glomerular basement membrane effacement (arrows). The basement membrane shows 100% foot process effacement without any electron-dense deposit.
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F2
Cytoplasmic swelling was noted in the proximal tubules (Figure 2A). Electron microscopy revealed lipid droplets, extensive microvillous transformation in visceral epithelial cells and 100% foot process effacement (Figure 2B).