PMC6657422_01
Serum creatinine trend over time.
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Figure1
Serum creatinine continued to worsen to 5.9 - 7.6 mg/dL, and glomerular filtration rate is now consistently less than 10 mL/min/1.73m2 (Figure 1).
A: Hematoxylin and eosin (H & E) stain of initial (6/2011) renal biopsy, x 20 magnification, demonstrating interstitial inflammatory infiltrate with normal glomerulus. B: H & E stain of initial renal biopsy (6/2011), x 40 magnification, depicting normal glomerulus and no glomerular hypercellularity, fibrinoid necrosis or crescent. C: H & E stain of third renal biopsy (2/2018), showing persistent interstitial inflammatory cell infiltrate and glomerulosclerosis. D: Trichrome stain of third (2/2018) renal biopsy, highlighting diffuse, extensive interstitial fibrosis and global glomerulosclerosis (blue).
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Figure2
There was no evidence of active glomerulonephritis (Figure 2A, B). This again demonstrated active interstitial nephritis without glomerulonephritis, now with severe interstitial fibrosis and tubular atrophy involving over 80% of the cortical parenchyma and global glomerulosclerosis (Figure 2C, D).