Case 100
With discussion
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CASE 100 (June 2014)

It is an honor for us to reach 100 cases of continuous publication, a case each month, 100 months from February 2006. Thank you for visiting us and joining us.

Clinical information

A 11-year-old boy is evaluated by presenting progressive edema in the past 3 months, with no other symptoms. The mother reports good growth and development, without apparent psychosocial distress.

Physical examination revealed no abnormalities, except for the described edema and systemic arterial pressure near the 95th percentile. No pathological personal antecedents. Family history: An uncle died of end-stage renal disease, unknown cause. His mother has chronic renal disease (not terminal) of unknown cause.

Laboratory: normal full blood count. Serum creatinine 0.7 mg / dL. ANA, anti-DNA: negative. Normal serum complement. Tests for B and C viruses were negative. Hypoalbuminemia and dyslipidemia. Urinalysis: proteinuria 2.4 mg/24 h; RBC: 10-12 /HPF, WBC: 1-2 / HPF; no casts.

With a diagnosis of nephrotic syndrome, a renal biopsy is done. See the images.

Figure 1. H&E, X200.

Figure 2. H&E, X200.

Figure 3. H&E, X400.

Figure 4. H&E, X400.

Figure 5. H&E, X400.

Figure 6. Methenamine-silver stain, X400.

Figure 7. PAS, X400.

Figure 8. PAS, X400.

Figure 9. Masson's trichrome stain, X400.

Figure 10. Methenamine-silver stain, X400.

Figure 11. Direct immunofluorescence for IgM, X400.

Figure 12. Indirect immunofluorescence for alfa-1 (MAB1) chain of type IV collagen, X400.

Figure 13. Indirect immunofluorescence for alfa-3 (MAB3) chain of type IV collagen, X400.

Figure 14. Indirect immunofluorescence for alfa-5 (MAB5) chain of type IV collagen, X400.

Figure 15. Positive control (normal kidney) for alfa-3 (MAB3 - left) and alfa-5 (MAB5 - right) chains of type IV collagen, X400.

Immunofluorescence for IgA, IgG, C3 and C1q: Negative.

What is your diagnosis?

See diagnosis and discussion