PMC4065736_01
Computed tomography (CT) scan of the abdomen/pelvis without contrast revealing bilateral enlarged and edematous kidneys.
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An ultrasound revealed enlarged kidneys with diffuse increased echogenicity and a computed tomography (CT) scan of the abdomen/pelvis without contrast revealed bilateral enlarged and edematous kidneys, scattered abdominal and pelvic ascites, and moderate soft tissue anasarca (Figure 1).
Light microscopy. (a) Shrunken glomerular tuft with dilated urinary space (arrows), (b) glomerular segmental sclerosis (arrows) with interstitial fibrosis, tubular degenerative/regenerative changes, and (c) tubular cystic dilatation (arrows) (H&E stain: (a) x10, (b) x10, and (c) x20). Electron microscopy. (d) Several protein droplets in visceral Bowman's epithelium (arrows), (e) mesangial sclerosis with increased mesangial cellularity (arrows), and (f) dilated urinary space and tubuloreticular inclusions in tuft endothelium (arrow). No disruption or electron dense deposits in GBM (EM: (d) x1900, (e) x1900, and (f) x30000).
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Light microscopy of the renal cortical tissue showed marked diffuse tubular degenerative and regenerative changes with interstitial fibrosis, focal microcystic tubular dilatation, and hyaline casts (Figures 2(a), 2(b), and 2(c)). Endothelial tubuloreticular inclusions most consistent with HIVAN were also visualized (Figures 2(d), 2(e), and 2(f)).
Immunofluorescence study negative for IgA, IgG, C3, and C1q (albumin control).
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The glomeruli showed focal segmental sclerosis with no evidence of crescentic glomerulonephritis and immunofluorescence revealed no specific immunoglobulin or complement deposits (Figure 3).