CASE 103 (September 2014)
The patient is a 56-year-old female with nephrotic range proteinuria. Serum creatinine: 1.1 mg/dL, 24h proteinuria: 5.9 g. She has no evidence of a paraprotein. Urine sediment without casts; erythrocytes: 4-5 hpf. She has a 10 years history of systemic hypertension, currently controlled. She also has a 3 years history of diabetes. Inmunologic and infectious tests: Negative or normal. Mild dyslipidemia.
A renal biopsy is performed.
Case prepared by Dr. Carlos Andrés Jiménez.
Figure 1. H&E, X200.
Figure 2. H&E, X200.
Figure 3. H&E, X400.
Figure 4. Methenamina-silver, X400.
Figure 5. Methenamina-silver, X400.
Figure 6. Methenamina-silver, X400.
Figure 7. Direct inmunofluorescence for IgG, X400. Kappa and lambda were both similar to IgG. C3: ++, in the same localization as IgG.
Figure 8. Electron micrograph,voriginal magnification, X6,000.
Figure 9. Electron micrograph; a close up of the previous image.
Figure 10. Electron micrograph, original magnification, X30,000.
Direct immunofluorescence for IgA, IgM and C1q: negative. Congo red: Negative.
What is your diagnosis?