Necrotizing Vasculitis as seen with Silver Methenamine Masson’s Trichrome (SMMT) stain on a renal biopsy. The immunofluorescence panel was negative (pauci-immune). Renal biopsies contain small arteries and thus this is consistent with granulomatosis with polyangiitis (GPA). The biopsy was obtained from an 87-year-old male who presented with hematuria, proteinuria and a creatinine of 2.5 mg/dl. Following the biopsy, ANCA serologies were ordered and cANCA positivity was found.
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