PMC6218875_01
Biopsy specimen with a portion of renal cortical and medulla containing 12 glomeruli, 2 of which were sclerotic. Three glomeruli presented slight segmental mesangial sclerosis, 2 others presented mesangial sclerosis and irregular thickening of blood vessel walls (due to ischemia). Diffuse edema, interstitial fibrosis, focal atrophy, and tubular deterioration were present among with diffuse lymphomonocytic infiltration with infiltration of the tubular tissue. Arteriosclerosis was present. Immunofluorescence tests were negative. Electronic microscopy was not performed. The specimen was compatible with FSGS and interstitial nephritis.
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Figure1
ART still discontinued, a new onset of AKI (serum creatinine levels 6.0 mg/dL) required hospital admission. A kidney biopsy was performed showing tubule-interstitial nephritis and focal glomerulosclerosis (Figure 1). Four weeks after the suspension of MMF, the patient experienced a new deterioration of liver and renal function that required the reintroduction of MMF, at a dosage of 500 mg b.i.d., and new hospital admission (Figure 1).
Serial serum creatinine and total bilirubin levels are reported with regard to immunosuppressive and anti-HCV treatment.
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Figure2
Then, methylprednisolone 40 mg daily was restarted with success (Serial serum creatinine levels are reported in Figure 2).