Figure 1

Glomerular and vascular findings from renal biopsy specimens in a patient with LPG and TMA. Panel A shows a glomerulus with the presence of intraglomerular lipoprotein thrombi due to deposition of lipid droplets within the diluted lumina of glomerular capillaries. Although lipoprotein thrombi were present in glomerular capillaries, the glomerulus still exhibited ischemic features (HE staining; ×200). In Panel B, the glomerulus shown in Panel A were enlarged (HE staining; ×400). In Panel C, glomeruli shown in Panel A were stained in PAS, also showing intraglomerular lipoprotein thrombi and ischemic features (PAS staining; ×200). In Panel D, lipid was stained positive (Oil Red O staining; ×400). In Panel E, a thrombus in the lumina of arteriole which extended to the vascular pole of the adjacent ischemic glomerulus is shown. Other arterioles also showed thrombus and pronounced swelling of endothelial cells (PAS staining; ×200). In Panel F, the thrombus in the arteriole extended to the vascular pole of an adjacent ischemic glomerulus shown in Panel E was enlarged (PAS staining; ×400). In Panel G, a glomerulus was shown with an extensive double-contour formation. Few red blood cells are observed in the capillaries. Adjacent arterioles with a swelling of endothelial cells and the presence of a fluffy material (fibrin) that caused a narrowing of vascular lumen are shown (PASM staining; ×400). In Panel H, endothelial swelling with mucoid change and chunks of fibrin in interlobular arteries are shown. In Panel I, the capillary lumen were occluded with various granule sizes. In Panel J, the subendothelial zone was focally expanded by electron-lucent material, and a new glomerular basement membrane was formed. Panels I &J are electron microscopy images.