CASE 3 (May 2006)
A 25-years-old woman presented with 10 days history of edema in face and legs, right knee pain, without arthritis signs, and no other symptoms. She relate that one-year ago was found hematuria: 50 eritrocites HPF, without proteinuria; she does not know about another tests. She does not have fever, weight loss, neither cutaneous alterations.
There was no personal or family history of major medical problems.
Physical examination revealed blood pressure: 190/100, there was no edema of papilla. Otherwise, the physical examination was unrevealing.
Urinalysis revealed 60 eritrocites HPF, proteins 4.27 g/24 h; a complete blood count was normal. Laboratory testing revealed normal liver function. Tests for antineutrophil cytoplasmic autoantibody, hepatitis B virus, ANAs, cryoglobulins, and hepatitis C virus were negative. C3 and C4 were normals. The creatinine level was 3.8 mg/dL on the first day, but it was 5.7 mg/dL on the seventh day. Renal sonography show chronic changes, poor cortico-medullary differentiation, but normal size.
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What is the differential diagnosis?
A renal biopsy was undertaken. See the images.
Figure 1. (H&E, x100)
Figure 2. (H&E, x400)
Figure 3. (H&E, x400)
Figure 4. (Methenamine silver stain, x400)
Figure 5. (Immunofluorescence using antiserum to IgA, X400)
Figure 6. (Immunofluorescence using antiserum to IgM, X400)
Immunofluorescence for IgG, C3, and C1q were negative.
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