Figure 2.

Drug induced TMA. (A) A glomerulus from a patient treated with gemcitabine exhibits subacute findings of thrombotic microangiopathy, including global double contours of the glomerular basement membrane (tram tracking), cellular interposition, and dissolution of the mesangial matrix consistent with mesangiolysis. Mild swelling of endothelial and visceral epithelial cells is also noted. Jones methenamine silver, ×600. (B) A glomerulus from the same patient exhibits a fresh fibrin thrombus in a preglomerular arteriole. Hematoxylin and eosin, ×600. TMA, thrombotic microangiopathy.