CASE 130 (December 2016)
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.
SECOND RENAL BIOPSY:
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?