A 68-years-old female patient referred for evaluation of acute kidney injury and new-onset proteinuria. Recently, the patient was diagnosed with autoimmune hemolytic anemia and thrombocytopenia.
Labs: sCrea: 1.43 mg/dL (baseline: 0.5 mg/dL); albumin: 3.0 g/dL; UPCR: 1.3 g/g pf creatinine; UA: 3+ protein; 10-20 RBCs.
Serology: Normal C3; Normal C4; + ANA
A kidney biopsy is shown in figure 2.
The immunofluorescence is negative for IgG, IgA, IgM, C1q, and C3.
The biopsy shows:
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