PMC7443985_01
Serum creatinine (mg/dL) versus months after presentation with SRC.. BP: blood pressure; mg/dL: milligrams/deciliter; DBP: diastolic blood
pressure; H: hospitalization for renal crisis; mmHg: millimeters of mercury;
RBx: renal biopsy; SBP: systolic blood pressure; SBx: skin biopsy; sCr:
serum creatinine; SRC: scleroderma renal crisis. Black arrow:
corticosteroids 1 mg/kg; Red arrow: bevacizumab 1.25 mg injections x 2;
Green arrow: renal replacement therapy:hemodialysis.
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Figure 2 shows the trends of serum creatinine, systolic blood pressure, and diastolic blood pressures for this case.
Features of active thrombotic microangiopathy on renal biopsy: (a) arteries
with near-complete luminal occlusion by fibrointimal proliferation (arrows)
and adjacent ischemic tubulopathy (periodic acid Schiff stain, 100x); (b)
artery with mucoid intimal hyperplasia (arrow) (trichrome stain 200x); (c)
artery with "onion skin" change (trichrome stain 400x); and (d) "bloodless"
glomerulus (H&E stain, 400x).
10.1177_2050313X20952650-fig3.jpg
PMC7443985_01_10.1177_2050313X20952650-fig3.jpg
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The patient's renal biopsy (Figure 3) contained 57 glomeruli (1 globally sclerotic) and light microscopy demonstrated arteries with near-complete luminal occlusion by fibrointimal proliferation and adjacent ischemic tubulopathy.