Recurrent Pauci-immune Necrotizing Crescentic Glomerulonephritis in a Kidney Transplant Patient

The native kidney biopsy specimen shows numerous segmental scars with broad-based adhesions typical of the sclerosis ensuing from healed aggressive necrotizing crescentic lesions (Jones silver stain; original magnification, ×400).

In the first transplant biopsy specimen, there was a single small segmental glomerular basement membrane break with fibrinoid material within Bowman space. There also were red blood cells within Bowman space and in the surrounding interstitium (Jones silver stain; original magnification, ×200).

In the second transplant biopsy specimen, widespread segmental necrotizing lesions through the glomerular basement membrane breaks were present. The remaining part of the glomerular tufts did not show endocapillary proliferative lesions, and immunofluorescence study results were negative, indicative of pauci-immune necrotizing crescentic glomerulonephritis (Jones silver stain; original magnification, ×100).

The native kidney biopsy specimen shows a small area of segmental disruption of the glomerular tuft with surrounding extracapillary proliferation adjacent to an area of nonspecific segmental sclerosis. There is surrounding interstitial fibrosis and atrophy of tubules. Immunofluorescence study results were negative, and the glomerular tuft shows no proliferation (Jones silver stain; original magnification, ×100).