1 Department of Pathology and 2 Division of Nephrology, Stanford University Medical Center, Stanford, CA, USA, 3 Present address: Department of Pathology, Oregon Health and Science University, Portland, OR, USA
Correspondence and offprint requests to: Megan Troxell MD, PhD, OHSU Department of Pathology, L471, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA. Email: troxellm{at}ohsu.edu
A 33-year-old woman with pulmonary artery hypertension diagnosed 20 months previously, right heart failure, acute on chronic renal failure with creatinine of 4.7, and mild proteinuria, presented for renal biopsy to rule out lupus nephritis. Laboratory data included FANA positive at 1:1280 (homogeneous), positive anti-DNA antibodies at 1:320 and SSA (Ro) antibody positive at 192.
The biopsy demonstrated no evidence of immune complex-mediated disease, but instead revealed changes of chronic ischaemia including diffuse interstitial fibrosis with tubular atrophy. Glomeruli were enlarged, many with ischaemic retraction of the tuft, along with mild mesangial widening and increased mesangial cellularity. The most striking feature was marked juxtaglomerular apparatus (JGA) hyperplasia throughout the biopsy (Figure 1), in response to chronic systemic hypotension [1,2].
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