case_images: PMC8216373_01
case_images: Trending baseline creatinine from August 25, 2017, until November 27, 2019.
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case_images: While creatinine was normal (0.8) in May 2019 (Figure 1), it was noted to progressively worsen over the course of steroids, reaching 2.08 by November 2020 (Figure 2).
case_images: The blue arrow denotes creatinine when prednisone 1 mg/kg therapy was initiated on December 7, 2020.
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case_images: PMC8216373_01_10.1177_23247096211026500-fig2.jpg
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case_images: While creatinine was normal (0.8) in May 2019 (Figure 1), it was noted to progressively worsen over the course of steroids, reaching 2.08 by November 2020 (Figure 2).
case_images: Light microscopy of H&E (hematoxylin and eosin)-stained renal parenchymal biopsy at 40x magnification demonstrating a well-demarcated border between a region of dense inflammation (right) and uninvolved parenchyma (left). This demarcation is a typical finding in IgG4-related kidney disease. Arrow points to border.
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case_images: Kidney biopsy demonstrated chronic active tubulointerstitial nephritis on light microscopy, and immunofluorescence staining confirmed positive IgG4 staining (Figures 3-6).
case_images: Light microscopy of H&E (hematoxylin and eosin)-stained renal parenchymal biopsy at 100x magnification demonstrating (blue arrows) dense mononuclear tubulointerstitial infiltration. This finding is known to be seen in IgG4-related kidney disease.
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case_images: PMC8216373_01_10.1177_23247096211026500-fig4.jpg
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case_images: Kidney biopsy demonstrated chronic active tubulointerstitial nephritis on light microscopy, and immunofluorescence staining confirmed positive IgG4 staining (Figures 3-6).
case_images: Renal parenchymal biopsy at 100x magnification demonstrating positive IgG4 immunohistochemical staining (blue arrows), confirming IgG4-related disease.
case_images: 10.1177_23247096211026500-fig5.jpg
case_images: PMC8216373_01_10.1177_23247096211026500-fig5.jpg
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case_images: Kidney biopsy demonstrated chronic active tubulointerstitial nephritis on light microscopy, and immunofluorescence staining confirmed positive IgG4 staining (Figures 3-6).
case_images: Renal parenchymal biopsy at 40x magnification demonstrating positive IgG4 immunohistochemical staining (blue arrows), confirming IgG4-related disease.
case_images: 10.1177_23247096211026500-fig6.jpg
case_images: PMC8216373_01_10.1177_23247096211026500-fig6.jpg
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case_images: Kidney biopsy demonstrated chronic active tubulointerstitial nephritis on light microscopy, and immunofluorescence staining confirmed positive IgG4 staining (Figures 3-6).
case_images: Additional graph depicting the rise in creatinine on July 2, 2019, as well as when steroids were initiated on December 7, 2020 (blue arrow).
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case_images: Prednisone 1 mg/kg was initiated in December 2020 (Figure 7), with immediate improvement in renal function as evidenced by downtrending creatinine following initiation of high-dose steroids to 1.85 mg/kg even just a few weeks later.