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This biopsy is from a person in their 40’s, who presented with accelerated hypertension and blood pressure of 240/180 mm/Hg. Urinalysis showed 2+ protein and 2+ blood and his serum creatinine was 7.2 mg/dl. Further workup revealed a low platelet count at 90,000 and schistocytes on peripheral smear. He was admitted to the ICU where careful hypertension management was instituted. Serologies were negative for ANA, cANCA, pANCA, anti-GBM, and hepatitis B and C. Complements were normal. ADAMTS-13 was normal. Diagnosis: Thrombotic Microangiopathy Global Glomerulosclerosis (20/72). Interstitial Fibrosis, Severe. Arteriosclerosis and Arteriolar Hyalinosis, Severe. Discussion: Thrombotic microangiopathy is a pattern that...