PMC4251529_01
Renal biopsy - light microscopy.. Notes: Light microscopic examination of renal biopsy: (A) trichrome stain showing moderate tubular atrophy, interstitial fibrosis and interstitial inflammation (affecting 50% of cortical area). No interstitial granulomas are seen. (B) Hematoxylin and eosin stain of glomeruli showing glomerular crescent. (C) Trichrome stain of glomeruli showing necrotizing crescent. Out of 19 glomeruli examined, nine showed complete or near complete global sclerosis.
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The other biopsy findings included moderate tubular atrophy, moderate interstitial fibrosis with inflammation, and moderate arteriosclerosis (Figures 1 and 2).
Renal biopsy - immunofluorescence microscopy.. Notes: Immunofluorescence microscopy of renal biopsy (A and B): Immunofluorescence (IF) staining shows weak linear staining of glomerular basement membranes for IgG. Area of non-staining in figure B represents crescent. The IF was also positive for kappa and lambda light chains (not shown). Segmental glomerular tuft staining for IgM, C3, and fibrinogen were also positive (not shown). The linear staining for IgG was not seen in the previous kidney biopsy and suggests the possibility of coexistent pauci-immune glomerulonephritis and anti-glomerular basement membrane nephritis.
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The other biopsy findings included moderate tubular atrophy, moderate interstitial fibrosis with inflammation, and moderate arteriosclerosis (Figures 1 and 2).
Kidney biopsy from 3 years pre-presentation - light microscopy.. Notes: Light microscopy of kidney biopsy. (A) Hematoxylin and eosin (H&E) stain of glomeruli showing cellular crescent. (B) H&E stain of another glomeruli showing cellular crescent. (C) Trichrome staining of glomeruli showing necrosis (red). (D) Trichrome staining of another glomeruli, showing necrosis (red). (E) Trichrome staining showing moderate tubular atrophy and interstitial fibrosis. Immunofluorescence staining was negative (not shown). Electron microscopy revealed 30% foot process effacement but no immune type electron dense deposits or endothelial tubuloreticular inclusions (not shown).
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The patient had a history of GPA and initially presented with PICGN and crescentic glomerulonephritis with negative IF findings 2 years previously (Figure 3).