case_images: PMC11735058_01
case_images: Light microscopy findings of renal biopsy. The histological pattern was mild mesangial proliferative glomerulonephritis: periodic acid-Schiff (PAS) stain, 400x; periodic acid methenarnine silver (PAM) stain, 400x. There was interstitial fibrosis and tubular atrophy but no noncaseating granulomas or tubulointerstitial nephritis (masson trichrome stain, 100x).
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case_images: Almost all the glomeruli showed mild mesangial proliferation (Figure 1). Although Masson trichrome staining showed 60% interstitial fibrosis and tubular atrophy, noncaseating granulomas were not seen in the biopsy sample (Figure 1).
case_images: Immunofluorescence analysis of glomeruli. Immunofluorescence analysis was performed using fluorescein-isothiocyanate-conjugated antibody against IgG, IgA, Gd-IgA1, IgM, C3, and C1q. There was strong glomerular staining of IgA (2+), Gd-IgA1 (1+), and C3 (1+) in the mesangial area, while IgG, IgM and C1q were all negative.
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case_images: Immunofluorescence studies showed strong staining of IgA, Gd-IgA1 and complement component C3 throughout the mesangial area (Figure 2).
case_images: Electron microscopic analysis of glomeruli. Electron microscopy revealed electron-dense deposits (EDDs; white arrows) in the mesangial areas.
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case_images: fig3
case_images: Electron microscopy revealed electron-dense deposits in the mesangial area (Figure 3).
case_images: Light microscopic findings of liver biopsy. There was inflammation with multiple noncaseating granulomas (white arrows) in the liver tissue (hematoxylin and eosin [HE] stain, 100x). There were some asteroid bodies (white circle) and some multinucleated giant cells (white dot circle) in the center of the noncaseating granulomas (hematoxylin and eosin [HE] stain, 400x).
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case_images: fig4
case_images: Liver biopsy was also performed because of clinical suspicion of sarcoidosis, which showed inflammation with multiple noncaseating granulomas (Figure 4).
case_images: Immunofluorescence analysis of liver. Immunofluorescence analysis was performed using fluorescein-isothiocyanate-conjugated antibody against Gd-IgA1. There was no staining of Gd-IgA1.
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case_images: Immunofluorescence studies showed no staining of Gd-IgA1 in the liver (Figure 5).
case_images: Clinical course of the patient. Alb, albumin; Cr, creatinine; ACE, serum angiotensin-converting enzyme; PSL, prednisolone. PSL, dose given in mg/day.
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case_images: fig6
case_images: The patient was treated with oral prednisolone at 30 mg/day (0.6 mg/kg), which was gradually reduced to 5 mg/day over 5 months (Figure 6). After treatment, mild proteinuria persisted; however, serum creatinine level was normalized, and hematuria disappeared (Figure 6).