This renal biopsy illustrates severe chronic kidney injury and its effects on all major compartments of the cortex: most glomeruli are globally sclerotic, the atrophic tubules are widely spaced, the interstitium is fibrotic, and the arterial walls show intimal fibrosis. Interestingly, such morphologic changes can either result from acute renal injury followed by weeks to months of ongoing damage or an insidious, decades-long kidney disease without an identifiable acute event. The degree of chronic injury should help inform the selection and aggressiveness of therapy and provide an objective measure of the likelihood of functional recovery.
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