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This photomicrograph shows an artery with intimal edema and inflammation in a renal biopsy from a 56-year-old male with renal failure and nephrotic-range proteinuria. The patient’s serologic workup revealed evidence of an HCV infection and a positive rheumatoid factor. While the intima is inflamed and edematous, the media is relatively intact without inflammation or necrosis. Intimal arteritis is a pattern of vascular inflammation most commonly encountered in the transplant setting where it represents a rejection process. In the native kidney, this finding is most commonly seen in cryoglobulinemic vasculitis (which was the case for this patient). The differential diagnosis would...