PMC4791296_01
PMC4791296_02
Renal biopsy. Renal biopsies showed glomeruli with segmental thickening and
enlargement of the mesangial axes (a), while a few ones were completely sclerotic (b),
resembling a focal segmental glomerulosclerosis. Some of the glomeruli showed initial
formation of florid crescents and small flocculo-capsular synechiae (e). Glomeruli had
slightly thickened basal membranes and coarse mesangial deposits (c, f). Broad areas
of tubular atrophy and interstitial fibrosis were present (d). Arteries has variable
degree of fibrosis (g).
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HRCT performed after diagnosis of IgA nephropathy. The scans show diffuse
centrilobular and para-septal emphysema, more profuse at higher lobes. High density
nodules were randomly diffused: in subpleural position, they were accompanied by
subpleural thickening, in particular at left superior lobe in dorsal position (a, b,
c). Mediastinal lymph-nodes appeared enlarged, in particular at left hilum. Scant
peribronchial thickenings were diffusely identified, and more evident in right lower
lobe, whereas a mild, diffuse interstial involvement was evident at left basis (images
c and d). Prone position was necessary in order to avoid the gravity dependent
opacities that could have obscured the subtle interstitial changes of this early stage
of silicosis.
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A high resolution chest tomography (HRCT) was performed (Fig. 2) and resulted positive for diffuse centrilobular and paraseptal emphysema, more profuse in the upper lobes.
High resolution Chest Tomography performed at the relapse of IgA nephropathy (18
months after the first episode). The direct comparison with the previous scans
suggests a significant progression of the underlying emphysema, with bilateral
centrilobular and parasettal pattern and traction bronchiectasis at lower fields
(D-I). High density nodularities appeared of increased diameter (1-2 mm) and more
profuse, in particular at hilar and subpleural level (B-F, see for comparison Fig. 2, a-c). Interstitial involvement was also
more evident, with a diffuse reticulo-nodular pattern (visual score 10%) (E-I).
Mediastinal lymph nodes appeared enlarged, in particular at paratracheal (maximal
diameter 2 cm) and para-aortic (maximal diameter 2.2 cm), deprived of calcifications,
suggesting a recent, acute and massive activation of immune system (A-C).
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Eventually, 18 months after the first episode, clinically relevant proteinuria (2,200 mg/24 h) was identified at urinalysis, suggesting a relapse of the IgA nephropathy (Fig. 3).