case_images: PMC10788082_01
case_images: First kidney biopsy. (A) The glomerular vascular pole is showing fibrinoid necrosis. A thrombus is also seen in one capillary lumen. The glomerulus has fibrillary appearance with duplication of the glomerular capillary basement membrane (H&E stain, 400x). (B) The glomerulus is showing mesangiolysis and the capillary lumina are occluded by homogenous eosinophilic thrombi (H&E stain, 400x). (C) There is fibrinoid necrosis with apoptotic bodies in the wall of this interlobular artery (H&E stain, 400x). (D) Few glomeruli are showing endocapillary hypercellularity that is associated with karyorrhexis (H&E stain, 400x)
case_images: cureus-0016-00000052248-i01.jpg
case_images: PMC10788082_01_cureus-0016-00000052248-i01.jpg
case_images: FIG1
case_images: Her kidney tests remained markedly deranged despite the initial therapy; therefore, we proceeded with kidney biopsy (Figure 1) which revealed several glomeruli showing capillary lumina filled with thrombi, double contour of glomerular capillary basement membrane, and mesangiolysis.
case_images: Second kidney biopsy. Features of lupus nephritis with endocapillary hypercellularity that is associated with karyorrhexis and wire loop lesion. No features of TMA are seen (H&E stain, 400x)
case_images: cureus-0016-00000052248-i02.jpg
case_images: PMC10788082_01_cureus-0016-00000052248-i02.jpg
case_images: FIG2
case_images: A new kidney biopsy was performed (Figure 2), and 17 out of 33 viable glomeruli showed endocapillary hypercellularity associated with karyorrhexis or leukocyte infiltration.
case_images: Change in proteinuria
case_images: cureus-0016-00000052248-i03.jpg
case_images: PMC10788082_01_cureus-0016-00000052248-i03.jpg
case_images: FIG3
case_images: After that, the levels of proteinuria decreased to 3100 mg/24 hours and serum creatinine improved to 93 mmol/L three months later (Figures 3, 4).
case_images: Change in serum creatinine
case_images: cureus-0016-00000052248-i04.jpg
case_images: PMC10788082_01_cureus-0016-00000052248-i04.jpg
case_images: FIG4
case_images: After that, the levels of proteinuria decreased to 3100 mg/24 hours and serum creatinine improved to 93 mmol/L three months later (Figures 3, 4).