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Clinical history:
61 year
old female with history of infective endocarditis
treated with cephalosporins, current blood cultures are
negative for past weeks, but now developing rash and
oliguric renal failure.
Histology: The glomeruli
are normocellular with thin, delicate peripheral
capillary loops and normal amounts of mesangial
matrix. There is diffuse and severe tubular epithelial
simplification with flattening of the epithelium,
dilation of the lumen and moderate loss of the brush
borders; the most distal tubuli show luminal cell
debris.
The observed changes are consistent with severe acute
tubular injury.
There is no evidence of interstitial fibrosis.
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