Pathology

A 33-year-old woman has had increasing lethargy and decreased urine output for the past week. Laboratory studies show her serum creatinine is 4.3 mg/ dL and urea nitrogen 40 mg/dL. A renal biopsy is performed, and the specimen is examined using electron microscopy. Which of the following morphologic cellular changes most likely suggests a diagnosis of acute tubular necrosis?