Quiz Page July 2010 American Journal of Kidney Diseases Hitomi Tanaka, MD, Takuma Fujii, MD, Takashi Kusaura, MD, Akiko Kobayashi, MD, Hisashi Oshiro, MD, PhD, Takeshi Sasaki, MD, PhD, Yutaka Yamaguchi, MD, PhD, Kiyotaka Nagahama, MD  American Journal of Kidney Diseases  Volume 56, Issue 1, Pages A35-A40 (July 2010) DOI: 10.1053/j.ajkd.2009.09.013 Copyright © 2010 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Chest computed tomographic (CT) scans and gallium scintigraphic images of the patient. (A) Chest CT scan shows multiple ill-defined consolidations with spiculation in bilateral lungs. (B) Gallium scintigraphy shows abnormal gallium accumulation in the hilar lymph nodes, lungs, and kidneys (arrows). American Journal of Kidney Diseases 2010 56, A35-A40DOI: (10.1053/j.ajkd.2009.09.013) Copyright © 2010 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 Microscopic analysis of biopsy specimens from the lung and kidney of the patient. Light microscopy of (A, B) transbronchial lung and (C-F) kidney biopsy specimens (A-D, hematoxylin and eosin stain; E, methenamine-silver stain; F, immunofluoresent immunoglobulin G staining). (G, H) Electron micrographs of the kidney biopsy specimen. American Journal of Kidney Diseases 2010 56, A35-A40DOI: (10.1053/j.ajkd.2009.09.013) Copyright © 2010 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 (A) Immunostaining showed that most immunoglobulin G (IgG)-bearing cells are (B) positive for IgG4. American Journal of Kidney Diseases 2010 56, A35-A40DOI: (10.1053/j.ajkd.2009.09.013) Copyright © 2010 National Kidney Foundation, Inc. Terms and Conditions

Figure 4 Consolidation lesions are diminished and inconspicuous in a follow-up chest computed tomographic scan for the patient after 3 months of prednisone therapy. American Journal of Kidney Diseases 2010 56, A35-A40DOI: (10.1053/j.ajkd.2009.09.013) Copyright © 2010 National Kidney Foundation, Inc. Terms and Conditions