PMC5505911_01
(a) The glomeruli are almost normal. (b) Immunofluorescence microscopy reveals granular IgG staining along the GBM, as well as weak staining for IgA and C3. (c) IgG subclass staining predominantly reveals IgG4. (d) Electron microscopy confirms numerous electron-dense subepithelial deposits under the GBM.
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There was no definite spike formation or bubbling of the glomerular basement membrane (GBM) and no cellular proliferation or expansion of the mesangial matrix (Fig. 1a). Immunofluorescence microscopy revealed granular IgG staining along the GBM, as well as weak staining for IgA and C3 (Fig. 1b). Staining of IgG subclasses revealed that IgG4 was predominantly positive (Fig. 1c). Electron microscopy confirmed the presence of numerous subepithelial electron-dense deposits under the epithelial cells, but definite spike-like protrusions arising from the GBM were not identified (Fig. 1d).
(a) Clinical course: 1 (on immunosuppressive therapy). PSL50mg eod: PSL at 50 mg every other day. PSL40mg ed: PSL at 40 mg every day. (b) Clinical course: 2 (on LDL-A)
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An angiotensin-converting enzyme inhibitor (ACE-I, captopril at 25 mg daily) and a statin (pravastatin sodium at 10 mg daily) were added and continued, but this regimen was not effective (Fig. 2a). After 2 years (at 63 years of age), immunosuppressive therapy including PSL and ACE-I was discontinued, and subsequently, LDL-A was commenced twice a month using an LDL sorbent column containing dextran sulfate cellulose beads (Liposorba LA-15) (Fig. 2b).