Case Report

A Case of Alport Syndrome with Posttransplant Antiglomerular Basement Membrane Disease despite Negative Antiglomerular Basement Membrane Antibodies by EIA Treated with Plasmapheresis and Intravenous Immunoglobulin

Figure 2

First renal biopsy. (a) Low power view shows a glomerulus with segmental fibrin deposition in the Bowman’s space. There is acute tubular injury with many red blood cell casts (H&E ×200). (b) Toluidine blue stained one-micron-thick section reveals a glomerulus with a small cellular crescent. (c) Immunofluorescence staining shows bright linear staining along the capillary walls for IgG. (d) Immunofluorescence staining discloses a segmental fibrinogen staining indicating necrosis/early crescent. Follow-up renal biopsies. (e) Low power view reveals two unremarkable glomeruli with mild tubular injury and few red blood cell casts (2nd biopsy, H&E ×200). (f) Low power view shows focal mild tubular atrophy and interstitial fibrosis. The glomeruli are largely unremarkable (3rd biopsy; H&E ×200).
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