PMC5660776_01
Clinical course. MP, methylprednisolone pulse therapy (1 g per day for 3 successive days); PP, plasmapheresis 7 times; PSL, prednisolone; KBx, kidney biopsy.
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fig1
Clinical course after admission was shown in Figure 1.
Light microscopic findings of 1st (a and b) and 2nd (c) kidney biopsies. (a) There are glomeruli demonstrating cellular or fibrocellular crescents with or without focal segmental necrosis and diffuse inflammatory cell infiltration, patchy tubular injury, and mild fibrosis in the tubulointerstitial areas (PAS staining, x200). (b) Immunofluorescent staining for IgG shows linear staining along with glomerular capillary walls, x400. (c) There are globally sclerotic glomeruli and diffuse tubulointerstitial fibrosis with mononuclear cell infiltration and tubular atrophy (Elastica-Masson staining, x200).
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fig2
Kidney biopsy at 16th day showed cellular or fibrocellular crescents with or without necrotic glomerular capillary walls in 19 of 22 glomeruli (86.3%) (Figure 2(a)). There were diffuse inflammatory cell infiltration, patchy tubular injury, and mild fibrosis in the tubulointerstitial areas (Figure 2(a)). Immunofluorescence for IgG showed 2+ linear staining along the glomerular capillary walls (Figure 2(b)). The second kidney biopsy at 65th day revealed 16 glomeruli with global sclerosis and 7 glomeruli with fibrous crescents out of 24 glomeruli and diffuse tubulointerstitial fibrosis with mononuclear cell infiltration and tubular atrophy (Figure 2(c)), indicating no active glomerular lesions.