PMC5291713_01
(A) Hematoxylin and eosin (H&E) stain demonstrating a glomerulus with a lobulated appearance, many lamellae containing scattered neutrophils, and prominent eosinophilic globules within capillary lumens. (B) Direct immunofluorescence demonstrating >2 coarse depositions of antibodies to IgG within the mesangium and capillary loops as well as focal staining of luminal plugs. (C) Ultrastructural examination revealing numerous immune-type subendothelial deposits.
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F1
Hemodialysis was started, and renal biopsy revealed typical findings of cryoglobulinemic glomerulonephritis (Figure 1).
(A) H&E and (B) trichrome stains demonstrating chronic HCV hepatitis with mild to moderate interface activity and focal bridging fibrosis (grade 1-2, stage 2-3).
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F2
Transjugular liver biopsy showed grade 1-2 inflammation and stage 2-3 fibrosis (Figure 2).
Follow-up renal biopsy with H&E showing a representative glomerulus that demonstrates significantly fewer inflammatory cells and thus improvement of disease activity.
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F3
Repeat renal biopsy revealed very low disease activity with healing lesions (Figure 3).