PMC3934786_01
Kidney biopsy revealed diffuse proliferative LN class IV-S (A/C). Four of 19 glomeruli presented crescent formation. a One glomerulus with fibrocellular crescent and widened mesangium (PAS staining, x400). b Capillary loop rupture with formation of a crescent and mesangial protein deposits (trichrome staining, x400). c, d Electron microscopy: peripheral capillary loop with subepithelial (black arrow) and subendothelial (white arrows) electron-dense deposits. e Tubulo-reticular structure in one endothelial cell (arrow).
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F1
IV-S (A/C; fig. 1). Immunofluorescence staining showed deposition of IgA, IgM, C1q, C3 and C5-9 in the mesangial area and peripheral capillaries.
Clinical course of the patient.
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F2
However, the serum concentration of creatinine gradually increased, so that again methylprednisolone pulses (500 mg/day for 2 days) were repeated on day 13, and high volume plasma exchange was started for 5 consecutive days to eliminate MPO-ANCAs (fig. 2).