PMC6595352_01
Glomerulus with segmental necrosis characterized by rupture of capillary wall and accumulation of fibrin and a segmental cellular crescent (by periodic acid-methenamine silver (PAM) with hematoxylin and eosin staining, original magnification 200x).
CRIN2019-4983139.001.jpg
PMC6595352_01_CRIN2019-4983139.001.jpg
fig1
This prompted a renal biopsy which revealed fibrinoid necrosis, capillary wall rupture, fibrin formation, and cellular crescents consistent with rapidly progressive crescentic glomerulonephritis (Figure 1).
No abnormal deposits found on sampled glomerulus.
CRIN2019-4983139.002.jpg
PMC6595352_01_CRIN2019-4983139.002.jpg
fig2
Examination of provided electron microscopy images showed 2 glomeruli which revealed no evidence of immune type electron dense deposits in the glomeruli, tubular basement membranes, or the interstitium (Figure 2).
Creatinine response to treatment regimen.
CRIN2019-4983139.003.jpg
PMC6595352_01_CRIN2019-4983139.003.jpg
fig3
After 7 sessions of plasmapheresis and treatment with 1200 mg IV cyclophosphamide, his creatinine stabilized at 1.7 mg/dL (Figure 3).