J Korean Med Sci.  2022 Oct;37(38):e298. 10.3346/jkms.2022.37.e298.

Case 3: A 81-Year-Old Man Presented With Abnormal Serum Creatinine Levels

• Youn S
• Kim JW
• Koh ES
• Choi BS
• Ban TH

• KMID: 2533566
• DOI: http://doi.org/10.3346/jkms.2022.37.e298

Figure

• 

  Fig. 1 Imaging studies of the patient. (A, B) Abdominopelvic CT included multiple simple cysts of both kidneys. (C) Chest CT suggested interstitial lung disease. (D) Kidney ultrasound observed normal size and parenchymal echogenicity of both kidneys.CT = computed tomography.

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  Fig. 2 Summary of treatment of the patient over time. On the 13th day after hospitalization, p-ANCA vasculitis was confirmed via kidney biopsy. As an induction treatment, the patient was treated with cyclophosphamide and plasmapheresis combined with high dose steroid. During the treatment, hemodialysis was withdrawn. Glucocorticoid was tapered for about four months. The patient was undergoing maintenance therapy with azathioprine and prednisolone.p-ANCA = perinuclear antineutrophil cytoplasmic antibody.

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  Fig. 3 Pathologic findings of kidney biopsy. (A) Subendothelial edema found through electron microscopy. (B) No evidence of deposition seen in immunofluorescence microscopic findings. Light microscopic findings via (C) Hematoxylin and eosin stain showing interstitial inflammation including mononuclear cell and neutrophilic infiltration, and (D) Periodic-acid Schiff stain showing a glomerulus with crescent and fibrinoid necrosis of vessel walls.

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