Case 73
With discussion
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CASE 73 (March 2012)

Clinical information

A 34-year-old woman presented with general malaise, fever, edemas and weigth loss for about 2 months. On admission BP: 100/60, heart rate: 96, respiratory rate: 22, Tº: 37.8 ºC., facial and legs edema; basal crepitus in left lung. No skin lesions; no organomegaly.

Hb: 9.3 mg/dL, hematocrit: 27%. On urinalysis: Proteinuria: 500 mg/dL (9.8 g/24h), erythrocytes 4-6/hpf, leukocytes: 6-8/hpf, granulaire and waxy casts. Serum creatinine: 13.0 mg/dL, BUN 106 mg/dL. PTH: 43,3 pg/mL Complement level was normal. ANA and ANCA were negative. Hepatotropic viruses: negative. ELISA for HIV: positive, pending the confirmatory test. Blood and urine culture: negative.

A renal biopsy was undertaken. See the images.

Figure 1. H&E, X200.

Figure 2. H&E, X400.

Figure 3. H&E, X400.

Figure 4. Masson's trichrome stain, X400

Figure 5. Methenamine-silver stain, X200.

Figure 6. Methenamine-silver stain, X400.

Figure 7. PAS, X400.

Figure 8. Direct immunofluorescence for C3, X400. Segmentary immunostaining in some glomeruli.

Figure 9. Direct immunofluorescence for IgM, X400. Segmentary immunostaining in some glomeruli.

Immunofluorescence for IgA, IgG, and C1q: Negative.

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