case_images: PMC11282913_01
case_images: Histopathological examination of the kidney reveals MN via periodic acid Schiff-methenamine staining (400x).
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case_images: The light microscopy analysis revealed 29 glomeruli, of which 5 showed glomerulosclerosis and the remaining 29 displayed mild hyperplasia of the mesangial tissue, basement membrane thickening, double tracks, nail processes, renal tubule atrophy, rare interstitial fibrous tissue hyperplasia, and inflammatory cell infiltration (<=5%) (Figure 1).
case_images: Immunohistochemical analysis of IgG4+ plasma cells < 10/high power field (Hp) (400x).
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case_images: Immunohistochemistry showed HBsAg (-), HBcAg (-), K (-), L (-), focal distribution of CD138-positive plasma cells in the renal interstitium with an average of 18/Hp, IgG4-positive plasma cells < 10/Hp (Figure 2), and PLA2R++ (capillaries, granular) (Figure 3).
case_images: Immunohistochemical analysis of the kidney reveals PLA2R++ (400x).
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case_images: Immunohistochemistry showed HBsAg (-), HBcAg (-), K (-), L (-), focal distribution of CD138-positive plasma cells in the renal interstitium with an average of 18/Hp, IgG4-positive plasma cells < 10/Hp (Figure 2), and PLA2R++ (capillaries, granular) (Figure 3).
case_images: Disease progression is monitored by quantifying serum proteinuria, serum albumin, serum IgG4 level, serum IgG level, and serum C3 level. T. wilfordii were administered after the initiation of prednisolone therapy. W = week.
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case_images: T. wilfordii (10 mg) was given and continued, until it was stopped 1 year ago (Figure 4). The serum anti-PlA2R became negative.