Nephropathology Since 2006
Case 130
With discussion
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CASE 130 (December 2016)

Clinical information

The patient is a 9-year-old boy. He has nephrotic syndrome since the age of two. There is no other personal history and there is no family history of kidney disease. Renal biopsy at 2 years of age was diagnosed as minimal change disease (no segmental lesions; negative immunofluorescence) (Figures 1-3). Multiple relapses: between 2 and 3 per year. Cortico-resistant in the last year. Serum creatinine one year ago: 0.6 mg/dL, now: 1.2 mg/dL. A new kidney biopsy was done.

See the images.

Figure 1. First biopsy. H&E, X100.

Figure 2. First biopsy. H&E, X400.

Figure 3. First biopsy. Masson's trichrome stain, X400.


Figure 4. H&E, X400.

Figure 5. H&E, X200.

Figure 6. H&E, X400.

Figure 7. PAS, X200.

Figure 8. PAS, X400.

Figure 9. Methenamine-silver stain, X400.

Figure 10. Methenamine-silver stain, X400.

Figure 11. Electron microscopy, X8,000.

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

What is your diagnosis?

Is it the same disease since the first biopsy or was there a "transformation" of the disease?

See diagnosis and discussion