case_images: PMC11789897_01
case_images: Histologic feature of renal biopsy. (A) Low power-view showing diffuse inflammatory infiltration in interstitium and necrotizing vasculitis (arrow; periodic acid-Schiff [PAS] stain, original magnification: x200). (B) Neutrophil dominant inflammatory infiltration is noted in interstitium and also in glomerular capillary lumina (PAS stain, original magnification: x400). (C) Other area showing interstitial fibrosis associated with diffuse lymphoplasmacytic infiltration (PAS stain, original magnification: x200). (D) Immunohistochemical staining for IgG4 showing markedly increased IgG4-positive plasma cells (>30 plasma cells/HPF) (original magnification: x400).
case_images: medi-104-e41410-g001.jpg
case_images: PMC11789897_01_medi-104-e41410-g001.jpg
case_images: F1
case_images: These findings were consistent with ANCA-associated glomerulonephritis, mixed class, and IgG4-RD (Fig. 1).
case_images: The clinical course after renal biopsy.
case_images: medi-104-e41410-g002.jpg
case_images: PMC11789897_01_medi-104-e41410-g002.jpg
case_images: F2
case_images: The patient had stable renal function with a creatinine level of 1.45 mg/dL after 2 years of initial diagnosis (Fig. 2).