CASE 62 (April 2011)
A 24-year-old woman was evaluated for malaise and back pain. She said having hyperpigmented urine and fever. There was not respiratory symptoms.
She had history of deaf-mutism from birth and recurrent urinary tract infections, none documented with urine culture. No family history of kidney disease or family history of hearing or visual impairment.
On physical examination: Blood pressure 100/60, heart rate: 70; no edema; no fever was detected in the 4 days of hospitalization. Fundus normal. No cardiorespiratory alterations. Ophthalmology found no evidence of disorders in the lens or the fundus.
Laboratory: CBC: normal; serum creatinine: 0.8 mg/dL. Urinalysis: D: 1,010; Proteins: 75 mg/dL; erithrocytes: 10 hpf; leukocytes: 10-12 hpf; nitrites: negative; no casts. Urine culture: negative. Renal ultrasound: normal, no evidence of stones. CT of urinary system: there is not obstruction, mass or stones. Proteinuria 24 hours: 904 mg. HIV: negative, tests for hepatitis viruses: negative. ANA: positive: 1:80, homogeneous pattern. Serum complement: C3 and C4 normal; anti-DNA: negative; ENA: negative.
What is your diagnosis based on the clinical and laboratory data?
A renal biopsy was performed. View the images.
Figure 1. Masson's trichrome stain, X100.
Figure 2. H&E, X400.
Figure 3. H&E, X400.
Figure 4.Masson's trichrome stain, X200.
Figure 5. methenamine-silver stain, X200
Figure 6. Direct immunofluorescence using antiserum to IgA (both), X400.
Figure 7. Direct immunofluorescence using antiserum to C3, X400.
Immunofluorescence staining for IgG, IgM, C1q, kappa, and lambda: Negative.
What is your diagnosis?