PMC4706724_01
Diffuse proliferative glomerulonephritis with leukocytic infiltration and polymethyl methacrylate microspheres in glomerular capillary lumens (HE x400)
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Fig1
Kidney biopsy (two cores; 9 and 11 mm long) containing 26 glomeruli, 2 of them completely sclerosed, disclosed diffuse proliferative glomerulonephritis characterized by glomerular hypercellularity due to mesangial proliferation and endocapillary leukocytic infiltration (Fig. 1). Round translucent, non-birefringent microspherical bodies (30-35 mum) resembling adipocytes were identified within some capillary lumens (Figs. 1 and 2).
a PMMA microspheres in a glomerulus (Jones silver stain x 400). b The finding of PMMA in a sclerosed glomerulus supports the permanent nature of this aesthetic filler (HE x400)
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Fig2
Jones silver stain did not show spikes or basement membrane reduplication (Fig. 2). Round translucent, non-birefringent microspherical bodies (30-35 mum) resembling adipocytes were identified within some capillary lumens (Figs. 1 and 2). Microspheres were also seen in a globally sclerosed glomerulus (Fig. 2).
a Immunofluorescence showing coarse granular C3 deposition along mesangial region with focal peripheral extension adopting a 'garland' pattern. b A detail of the glomerular tuft segment between 9 and 11 o'clock. Arrowheads pointing subepithelial deposits that correspond to the hump-shaped deposits seen by EM (box c). (a: IF anti-C3 x200; c: TEM x20000)
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Fig3
Coarse mesangial and peripheral capillary loop staining for C3 was seen on immunofluorescence (Fig. 3), without IgG, IgA or IgM deposition. Ultrastructural study revealed subepithelial deposits ('humps') (Fig. 3).
Time-course of changes in serum creatinine (mg/dl), urinary albumin/creatinine ratio (UACR in mg/g), hematuria expressed as red blood cells per high power fields (RBC/hpf) and serum complement factor 3 (C3, mg/dl). Green line denotes normal values limit
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Fig4
Estimated glomerular filtration rate, C3 and microhematuria normalized at month 3, 5 and 12, respectively, while albuminuria progressively improved over the next 12 months (Fig. 4).