Fig. 1

Images of case 1. a-d. First biopsy of case 1 – a. Biopsy core showing diffuse acute tubular injury in the form of epithelial flattening, intra-luminal dilatation and variably prominent tubular cell nuclei; background interstitium shows fibrosis intermixed with edema (Masson trichrome stain; original magnification, × 100); b. Representative glomerulus from the biopsy appearing completely unremarkable (PAS stain; original magnification, × 400); c. electron microscopy view of one glomerulus showing complete foot process effacement over adjacent capillary loops (original magnification, × 6800); and d. Electron microscopy view showing complete foot process effacement over 2 facing capillary loops (original magnification, × 18,500); e-f. Second biopsy of case 1 - e. Representative glomerulus showing global collapse of capillary loops associated with circumferential podocyte capping and podocyte hypertrophy/hyperplasia (Jones methenamine silver; original magnification, × 400), and f. Electron microscopy view of one glomerulus showing complete foot process effacement over adjacent capillary loops (original magnification, × 6800)