Case 107
With discussion
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CASE 107 (January 2015)

Clinical information

The patient is a 27-year-old man with nephrotic syndrome, manifested with edema from about 5 months ago. He is inhabitant of the street, with no known history of previous illness. He is consumer of alcohol, cocaine and marijuana.

Mild hypochromic anemia. Platelets and leukocytes in normal ranges. Serum creatinine 1.9 mg/dL, BUN 28 mg/dL. Tests for hepatotropic viruses and HIV were negative. VDRL positive, FTA-ABS positive (syphilis). Autoimmunity tests were negative, normal serum complement. Proteinuria: 8.3 g/24h. Serum albumin 1.7 g/dL; total serum proteins: 3.7 g/dL.

See the images of the renal biopsy.

Figure 1. H&E, X100.

Figure 2. H&E, X400.

Figure 3. H&E, X400.

Figure 4. H&E, X400.

Figure 5. PAS, X100.

Figure 6. PAS, X400.

Figure 7. Masson´s trichrome, X400.

Figure 8. Masson´s trichrome, X400.

Figure 9. Methenamine-silver, X400.

Figure 10. Methenamine-silver, X400.

Figure 11. Methenamine-silver, X400.

Direct immnuofluorescence for IgA, IgG, IgM, C3, C1q, kappa, Lambda, and fibrinogen: Negative.

What is your diagnosis?

See diagnosis and discussion