case_images: PMC7738783_01
case_images: All the glomeruli displayed membranoproliferative features, with increased cellularity and a lobular pattern (a) (H-E, 400x). A single arteriole showed a luminal thrombus, composed of fibrin and platelets, together with blood extravasation and karyorrhectic debris (b) (H-E, 400x). CD61 immunostaining was performed (400x), which demonstrated platelet content (c).
case_images: CRIN2020-6679857.001.jpg
case_images: PMC7738783_01_CRIN2020-6679857.001.jpg
case_images: fig1
case_images: There were mild tubular atrophy and interstitial fibrosis as estimated at 15-20% (as shown in Figure 1).
case_images: Direct immunofluorescence on fresh frozen tissue was performed; no evidence of deposits was observed (a) (IgG, 400x). Direct immunofluorescence on paraffin-embedded, pronase-digested sections was carried out; in contrast to routine IF, there were deposits of IgG and kappa light chains in the capillary walls (b) (kappa, 400x).
case_images: CRIN2020-6679857.002.jpg
case_images: PMC7738783_01_CRIN2020-6679857.002.jpg
case_images: fig2
case_images: On the other hand, the IF on pronase-digested paraffin-embedded (IF-P) sections showed subendothelial deposits of IgG and kappa light chain (++/+++) with negative staining for C3 and lambda light chain (as shown in Figure 2).
case_images: Electron microscopy showed subendothelial and mesangial deposits (a) (10000x); for the most part, these were nonorganized; however, there were some fibrillary deposits with parallel arrangement measuring approximately 10-15 nm (b) (30000x).
case_images: CRIN2020-6679857.003.jpg
case_images: PMC7738783_01_CRIN2020-6679857.003.jpg
case_images: fig3
case_images: The immunohistochemistry technique for DNAJB9 was negative, which ruled out FG (as shown in Figure 3).