case_images: PMC6657422_01
case_images: Serum creatinine trend over time.
case_images: CNCS-7-046-01.jpg
case_images: PMC6657422_01_CNCS-7-046-01.jpg
case_images: Figure1
case_images: Serum creatinine continued to worsen to 5.9 - 7.6 mg/dL, and glomerular filtration rate is now consistently less than 10 mL/min/1.73m2 (Figure 1).
case_images: A: Hematoxylin and eosin (H & E) stain of initial (6/2011) renal biopsy, x 20 magnification, demonstrating interstitial inflammatory infiltrate with normal glomerulus. B: H & E stain of initial renal biopsy (6/2011), x 40 magnification, depicting normal glomerulus and no glomerular hypercellularity, fibrinoid necrosis or crescent. C: H & E stain of third renal biopsy (2/2018), showing persistent interstitial inflammatory cell infiltrate and glomerulosclerosis. D: Trichrome stain of third (2/2018) renal biopsy, highlighting diffuse, extensive interstitial fibrosis and global glomerulosclerosis (blue).
case_images: CNCS-7-046-02.jpg
case_images: PMC6657422_01_CNCS-7-046-02.jpg
case_images: Figure2
case_images: There was no evidence of active glomerulonephritis (Figure 2A, B). This again demonstrated active interstitial nephritis without glomerulonephritis, now with severe interstitial fibrosis and tubular atrophy involving over 80% of the cortical parenchyma and global glomerulosclerosis (Figure 2C, D).