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FIGURE 9-1 (see Color Plate)

A large epithelial crescent fills Bowman's space and compresses the capillary loops in the glomerular tuft. This silver stain highlights the glomerular mesangium and the basement membrane of the glomerular capillaries (silver stain, original magnification X 400). The patient presented with hematuria and acute renal failure. Immunostains were negative in this case, a finding consistent with a pauci-immune process. The differential diagnosis includes small vessel vasculitis, and anti-neutrophil cytoplasmic antibody may be positive. Crescentic glomerulonephritis may also occur with anti-glomerular basement membrane antibody disease, or as a complication of immune complex glomerulonephritis [2].

FIGURE 9-1 (see Color Plate)

Early postinfectious glomerulonephritis. Numerous polymorphonuclear leukocytes in glomerular capillary loops contribute to the hypercellular appearance of the glomerulus. There is also a segmental increase in mesangial cells (hematoxylin and eosin, original magnification X 400). This reactive inflammatory process occurs in response to glomerular deposition of immune complexes, including the large subepithelial "hump-like" deposits which are typical of post-infectious glomerulonephritis. The glomerulonephritis is usually self-limited and reversible, and especially with appropriate treatment of the underlying infection, long-term prognosis is excellent [1].

FIGURE 9-2 (see Color Plate)

A large epithelial crescent fills Bowman's space and compresses the capillary loops in the glomerular tuft. This silver stain highlights the glomerular mesangium and the basement membrane of the glomerular capillaries (silver stain, original magnification X 400). The patient presented with hematuria and acute renal failure. Immunostains were negative in this case, a finding consistent with a pauci-immune process. The differential diagnosis includes small vessel vasculitis, and anti-neutrophil cytoplasmic antibody may be positive. Crescentic glomerulonephritis may also occur with anti-glomerular basement membrane antibody disease, or as a complication of immune complex glomerulonephritis [2].

FIGURE 9-3 (see Color Plate)

Urine sediment of a patient with acute renal failure revealing red blood cells and some red blood cell casts (original magnification X 600). Biopsy in this case revealed crescentic glomerulonephritis. However, hematuria may be seen in any proliferative glomerulonephritis or with parenchymal infarcts. The "casts" assume the cylindrical shape of the renal tubules, and confirm an intrarenal source of the blood in the urine. Fragmented or dysmorphic red blood cells may be seen when the red cells have traversed through damaged glomerular capillaries.

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