PMC9976264_01
Renal biopsy showing diffuse proliferative lupus nephritis International Society of Nephrology/Renal Pathology Society (ISN/RPS) class IV with 58% global glomerulosclerosis, moderate interstitial fibrosis/tubular atrophy involving 45% of the renal cortex, and acute thrombotic microangiopathy.. A: H&E stain, 400x original magnification - thrombotic microangiopathy with thrombus and fragmented red blood cells.. B: H&E stain, 400x original magnification - necrotizing glomerulonephritis.. C: H&E stain, 400x original magnification - fibrinoid necrosis of glomerular tuft.. D: IF stain, 400x original magnification - IgG.. E: IF stain, 400x original magnification - IgA.. F: IF stain, 400x magnification - C1q.. G: Silver stain, 400x original magnification - double contours.. H: Trichrome stain, 400x original magnification - interstitial fibrosis.. I: TEM stain, 400x original magnification - subendothelial and mesangial electron-dense deposits.. J: TEM stain, 400x original magnification - subendothelial and intramembranous electron-dense deposits.. H&E: hematoxylin and eosin; IF: immunofluorescence; TEM: transmission electron microscopy.
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FIG1
A repeat kidney biopsy was done, which revealed diffuse proliferative lupus nephritis International Society of Nephrology/Renal Pathology Society (ISN/RPS) class IV with 58% global glomerulosclerosis, moderate interstitial fibrosis/tubular atrophy involving 45% of renal cortex and acute thrombotic microangiopathy, index of activity 12/24, and index of chronicity 9/12, as shown in Figure 1.
Non-contrast MRI of the brain with posterior (blue arrows) and frontoparietal (white arrows) extensive bilateral cerebral and cerebellar deep white matter high-intensity signals.
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FIG2
A non-contrast head CT scan showed extensive bilateral frontoparietal and occipital cortical and subcortical hypoattenuation foci suggestive of lupus cerebritis versus PRES and a non-contrast MRI showed extensive bilateral cerebral and cerebellar deep white matter high-intensity signals, as shown in Figure 2.