CASE 136 (June 2017)
A 21-year-old woman with no medical history, presented spontaneous abortion at 17 weeks of gestation. A few days after fetal loss, she presents with edema and anuria.
Laboratory tests: Hb: 9.3 mg/dL, hematocrit:: 28%, platelets: 73,000, leukocytes: 9,800, neutrophils 78%. VGS: 19 mm/hr. Serum creatinine: 3.6 mg/dL, BUN: 68 mg/dL. ANA, anti-DNA and ANCA: negative. C3: 68 mg/dL (90-180), C4: 14 mg/dL (10-40). Studies for viruses: Negative.
An kidney biopsy was done. See the images.
Figure 1. H&E, X100.
Figure 2. H&E, X200.
Figure 3. H&E, X200.
Figure 4. H&E, X400.
Figure 5. Methenamine-silver staining, X400.
Figure 6. H&E, X400.
Figure 7. Masson's trichrome staining, X400.
Figure 8. Methenamine-silver staining, X400.
Figure 9. Masson's trichrome staining, X400.
Figure 10. Direct immunofluorescence for fibrinogen, X400.
Figure 11. Direct immunofluorescence for fibrinogen, X400.
Direct immunofluorescence for IgA, IGg, IgM, C3, and C1q: Negative.
What is your diagnosis?