CASE 141 (November 2017)
The patient is a 37-year-old woman diagnosed with systemic lupus erythematosus 8 years ago. Multiple cutaneous, articular and hematological alterations. He has received treatments with steroids, cyclophosphamide, hydroxychloroquine, among others. She now presents renal compromise, with serum creatinine of 2.1 mg/dL, subnephrotic proteinuria, microhematuria and active urinary sediment. A renal biopsy is performed.
Look at the images.
Figure 1. H&E, X400.
Figure 2. Masson's trichrome stain, X400.
Figure 3. Methenamina-silver stain, X400.
Figure 4. Direct immunofluorescence for IgG, X400. IF for IgA, IgM, C3 and C1q were similar to IgG.
Figure 5. EM, original magnification X3,000.
Figure 6. EM, original magnification X6,000.
Figure 7. EM, original magnification X4,000.
Figure 8. EM, original magnification X4,000.
Figure 9. EM, original magnification X4,000.
What is your diagnosis? What are the laminated inclusions evidenced in podocytes?