Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website http://www.journalmc.org

Case Report

Volume 9, Number 7, July 2018, pages 229-232

Bloodless Glomeruli: A Case Report on Scleroderma Renal Crisis

Figures

Figure 1.
Figure 1. Peripheral blood smear shows multiple schistocytes (black arrows) and burr cells (red arrows).
Figure 2.
Figure 2. Periodic acid-Schiff stain: the glomerulus demonstrates global collapse of glomerular capillaries with “bloodless” appearance.
Figure 3.
Figure 3. Silver stain: the glomerular basement membrane (GBM) is diffusely wrinkled and collapsed, findings similar to ischemic changes. But no microthrombi or widening of subendothelial space are seen in the glomerular capillaries. There are no crescent or proliferative changes.

Table

Table 1. Following Diagnostic Tests Were Ordered and the More Relevant Results Are Highlighted in Italic
 
Laboratory testResultsNormal values
ANAPositiveNegative
ANA pattern 1HomogeneousNA
ANA titer 1320 TUNA
ANA pattern 2NucleolarNA
ANA titer 2320 TUNA
Glomerular basement Membrane Ab, IgG< 0.2 AI0.0 - 0.9
Antineutrophil cytoplasmic antibody (C-ANCA)< 1:20< 1:20
Antineutrophil cytoplasmic antibody (P-ANCA)< 1:20< 1:20
Cardiolipin IgG< 9 GPL< 15 GPL
Cardiolipin IgM< 9 GPL< 15 GPL
Cardiolipin Ab, IgA< 9 GPL< 15 GPL
Rheumatoid factor-serum< 7.0 IU/mL0 - 14.0 IU/mL
RNP antibody< 0.2 AI0.0 - 0.9 AI
SSA Ab0.2 AI0.0 - 0.9 AI
SSB Ab< 0.2 AI0.0 - 0.9 AI
Smith Ab, IgG< 0.2 AI0.0 - 0.9 AI
Anti-dsDNA AbNon-detectedNon-detected
C346 mg/dL79 - 152 mg/dL
C418 mg/dL16 - 38 mg/dL
Anti-scleroderma-70> 8.0 AI0.0 - 0.9 AI
ADAMTS13 gene47%≥ 67%
Hepatitis A IgMNegativeNegative
Hepatitis B core antibody IgMNegativeNegative
Hepatitis B surface AgNegativeNegative
Hepatitis C AbNegativeNegative
HIV 1 and 2 screenNon-reactiveNon-reactive