PMC5557730_01
(A) (Above, left). Glomerular basement membrane irregular thickening and segmental spikelike projections were observed by periodic acid-silver methenamine staining. (B) (Above, middle). Granular fuchsinophilic protein was found to be subepithelial using Masson's trichrome staining. (C) (Above, right). Electron micrograph demonstrating a few electron-dense deposits in the subepithelial basement membrane and fusions of most foot processes. Depositions of IgG (D) (below, left) and C3 (E) (below, middle) are shown by immunofluorescence microscopy. (F) (Below, right). PLA2R1 is negative.
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F1
Segmental spikelike projections were observed with argentaffin staining, and subepithelial granular fuchsinophilic protein was found with Masson staining under optical microscope (Figures 1A,B). An electron micrograph demonstrated a few electron-dense deposits in the subepithelial basement membrane and the fusion of most foot processes (Figure 1C). Depositions of IgG (Figure 1D) and C3+ (Figure 1E) were revealed by immunofluorescence microscopy. Additionally, PLA2R1 was negative (Figure 1F), indicating the NS was secondary.
(A) (Above) course of proteinuria and serum albumin during treatments. Prednisone (2 mg/kg/day) and cyclosporine A (serum values maintained at 200-300ng/ml) was administrated to the patient for 8 weeks after Nephrotic syndrome diagnosis, but the urine protein remained at a high level. Rituximab was given intravenously at a dose of 100 mg weekly on day 1 of weeks 9, 10, 11, and 12. Mesenchymal stem cells (MSCs) from the bone marrow of a third-party donor were administered from weeks 13 to 18. The dose was 1 x 106 cells/kg/infusion with a total of six doses planned in weekly intervals. (B) (Below) TNF-alpha and IFN-gamma serum levels during treatments.
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F2
The 24-h urinary protein level and serum albumin level became normal at the sixth and 10th week after the first MSC infusion (Figure 2A).