case_images: PMC4025153_01
case_images: Microscopic findings. a Periodic acid-Schiff staining. x200. The glomeruli are hypertrophic, but thickening of the GBM is not apparent. A mild increase in mesangial matrix is occasionally noted, but mesangial cell proliferation is not obvious. b Periodic acid methenamine silver staining, x200. c Magnified view of b, x400. Spike formation or bubble-like appearance on the capillary walls is not apparent. d Electron microscopic findings. Irregular thickening of the GBM with diffuse subepithelial immune deposits (arrowheads) is observed along the entire capillary wall. Projection of the GBM (arrows) is noted between adjacent immune deposits, compatible with stage II MG. Intramembranous and subendothelial immune deposits are not apparent.
case_images: cru-0004-0060-g01.jpg
case_images: PMC4025153_01_cru-0004-0060-g01.jpg
case_images: F1
case_images: A kidney biopsy was performed (fig. 1, fig. 2); a total of 19 glomeruli were obtained from two pieces of specimen.
case_images: Clinical course. Percutaneous angioplasty for left subclavian artery stenosis was performed 5 years previously. Proteinuria was detected 4 months before admission. Kidney biopsy showed stage II MG and three-dimensional CT angiography confirmed the presence of TA. Oral PSL was initiated at a dose of 40 mg daily. CRP was normalized 7 days after the initiation of PSL therapy. Proteinuria decreased gradually. Three month later, proteinuria became <0.15 g/gCr. Eighteen months later, nephrotic syndrome and TA remain remitted with 5 mg PSL daily. During the clinical course, CRP increased twice due to colds. UP/UCr = Urinary protein to creatinine ratio.
case_images: cru-0004-0060-g03.jpg
case_images: PMC4025153_01_cru-0004-0060-g03.jpg
case_images: F3
case_images: PSL was gradually tapered to 5 mg daily and he remains free from relapse of both MG and TA (fig. 3).