PMC6959157_01
Kidney biopsy findings. (a): Light microscopic observation reveals glomeruli with slight enlargement. Periodic acid-Schiff staining. Original magnification x200. (b) One glomerulus with focal segmental sclerosis is found at a corticomedullary junction area (arrow). *; arcuate artery. Periodic acid-Schiff staining. Original magnification x200. (c) This glomerulus shows perihilar type of segmental sclerosis. Periodic acid-methenamine-silver staining. Original magnification x200. (d) Immunofluorescent finding shows linear alpha-2 (red) and alpha-5 (green) of type IV collagen staining along the glomerular basement membrane. Yellow stain indicates merged image of co-localization of alpha-2 (red) and alpha-5 (green) of type IV collagen.
CRIN2019-1627392.001.jpg
PMC6959157_01_CRIN2019-1627392.001.jpg
fig1
One glomerulus showed segmental sclerosis at the perihilar region, diagnostic of FSGS (Figures 1(a)-1(c)). Immunofluorescent study showed no deposition of immnoreactants and a preserved linear alpha-5 of type IV collagen staining (Figure 1(d)), supportive for TBMN rather than AS.
Electron micrograph of a glomerulus. Glomerular basement membranes are diffusely thinned without lamellation or reticular formation. Overlying podocytes are fairly preserved with focal foot process effacement. There are no electron dense deposits within glomerular capillary walls and a mesangial region. A red blood cell is seen in Bowman's space. Bar =10.0  mum. Inset; Peripheral glomerular capillary wall. Bar =1.0 mum.
CRIN2019-1627392.002.jpg
PMC6959157_01_CRIN2019-1627392.002.jpg
fig2
Electron microscopy showed thinning of the glomerular basement membrane (GBM) (GBM width between 140 nm and 250 nm) without splitting or lamellation, fulfilling the diagnostic criteria of TBMN (Figure 2). Foot process effacement was partial, and glomerular epithelial detachment was not seen (Figure 2).