PMC3573803_01
Multiple pathologies in a single kidney biopsy. a Segmental sclerosis in a glomerulus. An increased paucicellular matrix, hyalinosis, endocapillary foam cells and wrinkled basement membrane (single arrow) are shown. Periodic acid-Schiff stain. x200. b Superimposed preeclampsia. The glomerulus shows a 'bloodless' appearance with a swelling of the capillary endothelial cells and occluded or narrowed lumens, i.e. endotheliosis (single arrow). Mild vacuolation is noted in some endothelial cytoplasm. Hematoxylin and eosin stain. x400. c Hypertension. The interlobular artery shows thickening of the wall with subintimal fibrosis, consistent with hypertensive disease (single arrow). Gomori trichrome stain. x400. d Acute tubular necrosis. There is thinning of the tubular epithelium (single arrow) with loss of the nuclei, suggesting coagulative necrosis, and occasional mitotic figures (double arrows) can be seen. Hematoxylin and eosin stain. x400. e Focal segmental glomerulosclerosis. A marked foot process effacement in a non-sclerotic capillary loop without electron-dense deposits (single arrows). Electron micrograph. f Focal segmental glomerulosclerosis. Granular staining of C3 is noted in the glomerulus (single arrows). Immunoflourescence. x400.
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F1
A kidney biopsy was deemed necessary to explain the kidney failure (fig. 1a-f). The remaining two glomeruli had segmental sclerosis, with one showing adhesions to Bowman's capsule (fig. 1a). One of the glomeruli showed swelling of the capillary endothelial cells with narrowed lumen (endotheliosis) and mild vacuolation in the endothelial cytoplasm (fig. 1b). The interlobular arteries showed thickening of their wall with subintimal fibrosis, which reduced the lumen by up to 50% (fig. 1c). IgM (+/-), and moderately strong mesangial staining for C3 (2~3+). IgA, IgG and fibrinogen stains were negative (fig. 1f). Electron microscopy revealed extensive fusion of the podocyte foot processes and associated villous transformation (fig. 1e).
Trends in serum creatinine and serum albumin levels over a period of approximately 6.5 years (August 2004-March 2011).
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F2
The serum creatinine level improved from 2.4 mg/dl (212.16 micromol/l) to 2.1 mg/dl (185.64 micromol/l (fig. 2).
Trends in urine random protein/creatinine ratio over a period of 2 months (February-March 2011).
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F3
The urine protein/creatinine ratio had improved from 10.16 mg/mg to 5.57 mg/mg (fig. 3).