Nephropathology Since 2006
Case 131
With discussion
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CASE 131 (January 2017)

Clinical information

The patient is a 71-year-old woman with a history of hypertension, type 2 diabetes mellitus diagnosed one year before, without insulin requirement, and dyslipidemia. Its current paraclinics are creatinine 0.92 mg/dL, BUN 17 mg/dL, creatinine clearance: 65 mg/m2/h, proteinuria 816 mg/24 hours, albumin 3.58 g/L, Hb.: 8,1. Ht.: 25%; Phosphorus 5.54. Calcium 9.41. She has pain in the right thoracic wall of several months of evolution and some small lytic costal lesions.

See the images.

Figure 1. H&E, X400.

Figure 2. PAS, X400.

Figure 3. Masson's trichrome stain, X200.

Figure 4. Methenamine-silver stain, X400.

Figure 5. H&E, X200.

Figure 6. PAS, X400.

Figure 7. PAS, X400.

Figure 8. Masson's trichrome stain, X400.

Figure 9. Masson's trichrome stain, X400.

Figure 10. Masson's trichrome stain, X400.

Figure 11. Direct immunofluorescence for IgG, X400.

Figure 12. Direct immunofluorescence for kappa light chains, X400.

Figure 13. Direct immunofluorescence for lambda light chains, X400.

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

What is your diagnosis?

See diagnosis and discussion