PMC6462354_01
PMC6462354_02
Renal parenchyma mainly shows tubulointerstitial nephritis injury (HEx100)
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Renal biopsy report suggested a tubulointerstitial injury associated with thrombotic microangiopathy (Figure 1).
Lobular pattern of the glomeruli (HEx100)
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The glomeruli presented a diffuse lesion (Figure 2) with a lobular pattern due to intense mesangial cell proliferation and obliteration of the capillary lumen by mesangial, polymorphonuclear, and macrophage cells (Figure 3).
Lobular pattern of the glomeruli (HEx200)
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The glomeruli presented a diffuse lesion (Figure 2) with a lobular pattern due to intense mesangial cell proliferation and obliteration of the capillary lumen by mesangial, polymorphonuclear, and macrophage cells (Figure 3).
PAS staining (PASx200)
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PAS staining (Figure 4) showed diffuse and global glomerular lesions with a type 1 membranoproliferative pattern, showing mesangial increase of the matrix and its cells, with contracting the capillary lumens as well as the presence of macrophages, all of which causes a marked accentuation of the lobular pattern of the glomerular ball.
Immunofluorescence C3 studies (x200)
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Immunofluorescence showed intense diffuse positivity for capillary and moderate C3 (Figure 5), focal IgM, and IgG with traces of kappa and lambda.
A) capillary membranes were irregularly thickened and electron-dense intramembranous deposits (x5600); B) the tubular structures of 26 nanometers (x36000)
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Mild to moderate tubular atrophy and interstitial tubular fibrosis were observed (Figure 6A, Figure 6B).