Case 104
With discussion
Versión en Español

CASE 104 (October 2014)

Clinical information

The patient is a 62-year-old man. Four months of weight loss (7 kg), lower limb edema, mild dyspnea and foamy urine. Physical examination found no skin lesions and no neurological abnormalities.

Lab: Hb 7.9 mg/dL, hematocrit 23%, platelet count: 186,000 creatinine 2.3 mg/dL, BUN 72 mg/dL. Urinalysis: Proteinuria 5 g/24h; sediment: erythrocytes 3​​/HPF, leukocytes 10/HPF, cylinders not observed. Total cholesterol 250, triglycerides 180, Albumin 2.9 g/dL. PTH 55 pg/ml. Serum calcium 10.4 mmol/L.

A renal biopsy was performed. See the microscopic images.

Figure 1. Masson's trichrome stain, X200.

Figure 2. H&E, X400.

Figure 3. H&E, X400.

Figure 4. H&E, X400.

Figure 5. H&E, X200.

Figure 6. Masson's trichrome stain, X200.

Figure 7. Masson's trichrome stain, X400.

Figure 8. PAS, X400.

Figure 9. Masson's trichrome stain, X400.

Figure 10. Methenaime-silver stain, X400.

Figure 11. Congo red; right: polarized, X400.

Figure 12. Immunohistochemistry for kappa (left) and lambda (right), X400.

What is your diagnosis?

See diagnosis and discussion