Figure 1: (A) Sampling for light microscopy reveals a focal segmental necrotizing & crescentic glomerulonephritis, typical of what may be seen in the setting of ANCA seropositivity. (B) The findings are also notable for moderate to severe interstitial inflammation and extensive tubulitis which also likely relate to ANCA seropositivity. Immunofluorescence reveals granular global capillary wall positivity of 1-2+ intensity for IgG, C3, kappa, and lambda. Electron microscopy reveals minute, stage 1, predominantly segmental subepithelial deposits as well as infrequent segmental mesential deposits. Taken together, these findings appear sufficient to establish the Coexistent MN and ANCA-associated NCGN.