Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc
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Case Report

Volume 6, Number 2-3, September 2017, pages 52-58

Thrombotic Microangiopathy With Granulomatosis Interstitial Nephritis in an Allogenic Bone Marrow Transplant Patient: A Case Report and Review of the Literature

Figures

Figure 1.
Figure 1. Worsening renal function over time: from transplant to eventual hemodialysis.
Figure 2.
Figure 2. Worsening anemia in correlation with renal decline.
Figure 3.
Figure 3. The kidney biopsy tissue of the patient. (a) The glomerulus is slightly hypocellular, and most of the glomerular capillary lumina are closed due to thickening of the capillary walls. Red blood cells and fragmented cells are seen in the mesangial area (H&E, × 400). (b) Trichrome stain showing microthrombi in glomerular capillaries and focal reduplication of the glomerular capillary basement membranes (× 400). (c) Ectatic glomerular capillary lumina are present as a result of mesangiolysis. Focal reduplication of the glomerular capillary basement membranes is also present (Jones silver stain, × 400). (d) Focal non-caseating granuloma is present in the interstitium (black arrow, H&E, × 400). (e) Electron microscopy of glomerular capillary loops showing podocytes vacuolization, extensive effacement of foot processes (black arrow) and basement membrane reduplication (blue arrow). (f) Electron microscopy of glomerular capillary loops showing markedly narrowed capillary lumen and widening of the subendothelial spaces with electrolucent fluffy material (black arrow) and platelets (blue arrow).
Figure 4.
Figure 4. Chronic thrombocytopenia in the setting of chronic GvHD.