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This biopsy came from an elderly gentleman in his 80s, who presented with acute renal failure. His serum creatinine had increased from a baseline of 1.3 mg/dL up to 6.6 mg/dL. And in addition to that, urinalysis was positive for proteinuria and blood. His medical history included pulmonary embolism, BPH, gastrointestinal hemorrhage and GERD. Multiple serologies were ordered upon presentation, and among these, pANCA and MPO were markedly positive. A biopsy was performed to investigate the possibility of an ANCA-mediated crescentic glomerulonephritis. Unfortunately, the material obtained for biopsy was small in size, and the longest core, submitted to light microscopy,...