case_images: PMC6719466_01
case_images: Imaging studies: (a) chest x-ray anteroposterior view, (b) chest x-ray lateral view, (c) chest CT scan coronal section and (d) chest CT scan sagittal section.
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case_images: Chest x-ray showed vague pulmonary infiltrates, and the patient tested negative for tuberculosis (Figure 1). CT chest showed pulmonary parenchymal findings in keeping with an infectious process (Figure 1).
case_images: Laboratory changes in renal function.. eGFR: estimated glomerular filtration rate.
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case_images: The kidney function was normal at presentation and remained stable (within the normal range) throughout the follow-up period (Figure 2). Urinalysis showed 1+ haemoglobin and trace protein, and urine protein: creatinine ratio of 36.9 mg/mmol (Normal < 13 mg/mmol) (Figure 2).
case_images: Kidney biopsy: light microscopy - (a) PAS staining and (b) H&E - the glomerulus exhibits a cellular crescent with focal breach in the Bowman's capsule; no fibrinoid necrosis is seen; there were 11 glomeruli in the representative section, two contain segmental proliferative foci and remaining glomeruli show no conspicuous changes; mild intestinal edema and patchy mild interstitial fibrosis and tubular atrophy without segmental interstitial fibrosis; and vessels show no conspicuous changes. (c) Electron microscopy (EM) - the EM photomicrograph shows mild effacement of podocyte foot processes and a near break in the capillary basement membrane which is the cause of crescent; no immune complex deposition; and peritubular capillaries have normal structure.
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case_images: Based on the previous features of a systemic illness and new findings on urinalysis and urine microscopy, the patient underwent a kidney biopsy, and the tissue was analysed and reported by our pathology service (Figure 3).