case_images: PMC4706724_01
case_images: Diffuse proliferative glomerulonephritis with leukocytic infiltration and polymethyl methacrylate microspheres in glomerular capillary lumens (HE x400)
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case_images: PMC4706724_01_13000_2016_453_Fig1_HTML.jpg
case_images: Fig1
case_images: Kidney biopsy (two cores; 9 and 11 mm long) containing 26 glomeruli, 2 of them completely sclerosed, disclosed diffuse proliferative glomerulonephritis characterized by glomerular hypercellularity due to mesangial proliferation and endocapillary leukocytic infiltration (Fig. 1). Round translucent, non-birefringent microspherical bodies (30-35 mum) resembling adipocytes were identified within some capillary lumens (Figs. 1 and 2).
case_images: a PMMA microspheres in a glomerulus (Jones silver stain x 400). b The finding of PMMA in a sclerosed glomerulus supports the permanent nature of this aesthetic filler (HE x400)
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case_images: PMC4706724_01_13000_2016_453_Fig2_HTML.jpg
case_images: Fig2
case_images: Jones silver stain did not show spikes or basement membrane reduplication (Fig. 2). Round translucent, non-birefringent microspherical bodies (30-35 mum) resembling adipocytes were identified within some capillary lumens (Figs. 1 and 2). Microspheres were also seen in a globally sclerosed glomerulus (Fig. 2).
case_images: a Immunofluorescence showing coarse granular C3 deposition along mesangial region with focal peripheral extension adopting a 'garland' pattern. b A detail of the glomerular tuft segment between 9 and 11 o'clock. Arrowheads pointing subepithelial deposits that correspond to the hump-shaped deposits seen by EM (box c). (a: IF anti-C3 x200; c: TEM x20000)
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case_images: PMC4706724_01_13000_2016_453_Fig3_HTML.jpg
case_images: Fig3
case_images: Coarse mesangial and peripheral capillary loop staining for C3 was seen on immunofluorescence (Fig. 3), without IgG, IgA or IgM deposition. Ultrastructural study revealed subepithelial deposits ('humps') (Fig. 3).
case_images: Time-course of changes in serum creatinine (mg/dl), urinary albumin/creatinine ratio (UACR in mg/g), hematuria expressed as red blood cells per high power fields (RBC/hpf) and serum complement factor 3 (C3, mg/dl). Green line denotes normal values limit
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case_images: PMC4706724_01_13000_2016_453_Fig4_HTML.jpg
case_images: Fig4
case_images: Estimated glomerular filtration rate, C3 and microhematuria normalized at month 3, 5 and 12, respectively, while albuminuria progressively improved over the next 12 months (Fig. 4).