PMC8077465_01
Trend of serum creatinine (mg/dL), estimated glomerular filtration rate (mL/min), and platelet count versus time in the presented patient. Green line = serum creatinine (mg/dL) (left y axis); black line = eGFR (mL/min) (left y axis); red line = platelet count (x1,000/muL) (right y axis); black box = peripartum thrombotic microangiopathy/atypical hemolytic uremic syndrome presentation; black arrow = date of therapeutic abortion; red arrow and box = start and duration of cyclophosphamide treatment; green box = start and duration of eculizumab treatment.
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F1
Figure 1 shows the trend of renal function and platelets versus time. Figure 1 shows the platelet count and serum creatinine for our presented case.
Renal biopsy findings. a, b Light microscopy images demonstrating global endocapillary hypercellularity and crescent formation (a) and necrotizing arteritis (b). Periodic acid Schiff stain. x400. c, d Immunofluorescence microscopy images demonstrating a global granular capillary wall and mesangial IgG staining (c) and luminal fibrinogen staining in glomeruli and hilar arterioles (d). x400. e, f Electron micrographs demonstrating detachment of endothelial cells from basement membranes with interposition of electron-lucent material suggestive of active thrombotic microangiopathy.
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F2
The renal biopsy (Fig. 2) contained approximately 39 glomeruli (1 globally sclerotic) and demonstrated a diffuse active proliferative glomerulonephritis represented by diffuse endocapillary hypercellularity composed of swollen endothelial cells, leukocytes, frequent neutrophils/karyorrhectic debris, focal necrotizing lesions, focal large cellular crescents (~18% glomeruli involved), and rare large subendothelial (wire loop/hyaline pseudothrombus type) deposits.