CASE 79 (September 2012)
The patient is an infant of 9 months of age, female, without medical history and no family history of kidney disease. Seemingly sudden onset of nephrotic syndrome with generalized edema, hypoalbuminemia, dyslipidemia, and proteinuria of 120 mg/m2/hora.
Product of the first pregnancy, in which there were no complications, deliver at term. Normal growth and development. Except for the edema, physical examination was normal.
Serum creatinine: 0.3 mg/dL. Tests for hepatotropic virus, HIV and syphilis were negative. CBC and serum complement were normal. Urinalysis without casts or hematuria.
After two months of treatment with steroids, without response, a renal biopsy is undertaken. Creatinine had risen to 0.7 mg / dL.
See the images.
Figure 1. H&E, X200.
Figure 2. Masson's trichrome stain, X200.
Figure 3. H&E, X400.
Figure 4. H&E, X400.
Figure 5. Masson's trichrome stain, X400.
Figure 6. Masson's trichrome stain, X400.
Figure 7. Methenamine-silver stain, X400.
Figure 8. Methenamine-silver stain, X400.
Figure 9. Methenamine-silver stain, X400.
Figure 10. Immunofluorscence for IgM, X200.
Figure 11. Immunofluorscence for C3, X400.
Direct immunofluorescence for IgA, IgG, C1q, kappa, and lambda: Negative.
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