Case 69
With discussion
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CASE 69 (November 2011)

Clinical information

The patient is a 59 year-old woman who developed sepsis originating from diverticulitis of the colon. She needed partial colectomy and several surgeries later because of persistent intraabdominal infection. He has received several antibiotics, including cephalosporins, amikacin and colistin. Although there is marked improvement in sepsis and general conditions, begins to rise gradually creatinine to 5.8 mg/dL, BUN 98 mg/dL. Personal antecedents: systemic hypertension for 4 years, controlled with ACE inhibitors.

With the diagnosis of acute renal failure of unclear cause, 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. H&E, X400.

Figure 5. H&E, X400.

Figure 6. PAS, X400.

Figure 7. PAS, X400.

Figure8. Masson's trichrome stain, X200.

Figure 9. Masson's trichrome stain, X400.

Immunofluorescence staining for IgA, IgG, IgM, C3, C1q, kappa, and lambda: Negative.

What is your diagnosis?

See diagnosis and discussion