FIGURE 5.

Renal biopsy micrographs for Patient 2 showing diabetic nephropathy and focal and segmental sclerosis with collapsing features. Renal biopsy reveals underlying diffuse and nodular diabetic glomerulosclerosis (A, Jones methenamine silver 600×). There were lesions of segmental sclerosis with focal collapsing features (B, Trichrome stain 600×) characterized by capillary luminal obliteration by insudates and segmental tuft deflation, with overlying podocyte hyperplasia and prominent cytoplasmic vacuolization (black arrow). There was also concomitant acute tubular necrosis (C, asterisk, hematoxylin and eosin, 200×), with interstitial edema and a mixed interstitial inflammatory infiltrate (interstitial nephritis).