Case 109
With discussion
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CASE 109 (March 2015)

Clinical information

The patient is a 9-year-old boy. The clinical picture began eight days earlier with edema in face. He was evaluated as outpatient and cetirizine was formulated. The next day is evaluated by pedal edema, malaise and subjective fever; amoxicillin was formulated. Seven days after he was evaluated in the emergency room with generalized edema and anuria. Serum creatinine: 4.2 mg/dL, which increased to 5.4 mg/dL the following day. Mild tachycardia, without fever or neurological disorders. No skin lesions, organomegaly or other clinical alterations.

The tests were negative for autoimmunity. Tests for viruses: negative. With diagnostic impression of rapidly progressive glomerulonephritis a renal biopsy was done (see the pictures). After several days on dialysis, diuresis improves and proteinuria (120 mg/m2/h), dyslipidemia and hipoalbumunemia were documented.

Figure 1. H&E, X400.

Figure 2. Masson´s trichrome, X400.

Figure 3. PAS, X400.

Figure 4. H&E, X400.

Figure 5. H&E, X400.

Figure 6. PAS, X400.

Figure 7. H&E, X400.

Figure 8. Masson´s trichrome, X400.

Figure 9. Methenamine-silver, X400.

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

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