Fig. 2

Immunofluorescence microscopic images of six successive renal biopsies compared with various therapies. (First biopsy) Granular glomerular mesangial and particularly capillary wall immunofluorescence moderate staining for IgG, subclass IgG3 and intense bright staining for C3. (Second biopsy) Scanty segmental glomerular granular staining for IgG, subclass IgG3, and intense staining for C3. (Third biopsy) Negative immunofluorescence for IgG, subclass IgG3, and pattern and intensity of C3 as in previous two biopsies. (Fourth biopsy) After introduction of eculizumab therapy immunofluorescence showing moderate granular mesangial and capillary wall as well as extraglomerular vessel and extensive tubular staining for IgG2, IgG4, kappa. (Fifth biopsy) On persisting eculizumab therapy but withdrawal of conventional immunosuppression reappearance of immune complex pattern expressed as segmental granular staining for IgG1, while moderate granular glomerular, extraglomerular vascular and tubular staining for IgG4 and intense bright staining for C3 persist. (Sixth biopsy) After ongoing eculizumab and methyprednisolone therapy immunofluorescence showing only segmental scanty granular staining for IgG3, persisting glomerular and extraglomerular staining for IgG4 and still intense staining for C3