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This biopsy came from a 70-year-old gentleman with acute renal failure. He had a known history of diabetes, hypertension, and chronic kidney disease. His baseline serum creatinine is between 1.7 mg/dl and 1.9 mg/dl and was found to be elevated up to 2.9 mg/dl. Proteinuria was quantified as 0.2 g/g on urine protein to creatinine ratio. Urinalysis showed trace blood and protein. While processing the clinical information, one has to admit that this clinical presentation is not an unusual one. A fair number of patients will have a decline in renal function that reflects the reality of an already struggling...