case_images: PMC11347436_01
case_images: Renal pathology findings. (A) A glomerulus shows mesangial matrix expansion and hypercellularity. A few loops contain neutrophils. Crescents and fibrinoid necrosis are not present (Hematoxylin&Eosin). (B) A glomerulus shows PAS-positive mesangial nodules with lobular accentuation and focal double contouring (yellow arrow). There is some focal endothelial swelling (blue arrow) (Periodic Acid-Shiff: PAS). (C-E) Immunofluorescence studies following pronase digestion, the glomeruli are negative for lambda (C), IgG (D), and C3 (E). (F) Electron microscopy showed subendothelial expansion with cellular elements and fluffy material. Electron dense deposit is absent. Segments of double contours are present. A few loops show infiltrating leukocytes. The glomerular basement membranes appear thickened.
case_images: fneph-04-1400027-g001.jpg
case_images: PMC11347436_01_fneph-04-1400027-g001.jpg
case_images: f1
case_images: TMA, and are atypical in diabetic nephropathy. There were no electron-dense deposits or fibrils ( Figure 1 ).
case_images: Clinical course and treatment response of the patient. (A) Trend of white blood cell count after ibrutinib initiation. (B) Trends of serum creatinine and proteinuria after ibrutinib initiation.
case_images: fneph-04-1400027-g002.jpg
case_images: PMC11347436_01_fneph-04-1400027-g002.jpg
case_images: f2
case_images: Her WBC count progressively decreased ( Figure 2A ) along with an overall improvement of her SCr and urine protein levels ( Figure 2B ).