CASE
85 (March 2013)
Clinical information
The patient is a 58 year old white male,
not diabetic, admitted with serum creatinine 2.4 mg/dL, uncontrolled hypertension:
175/120 mm/Hg, microhematuria and proteinuria in nephrotic range: 5.2
g/24h.
ANA and ANCA negative. Serum complement:
normal. Cryoglobulins: negative. HIV, hepatitis B and C: negative. Mild
anemia. Platelets: 235.000/mm3.
A renal biopsy was performed. See the
images.

Figure 1.
H&E, X200.

Figure 2.
H&E, X400.

Figure 3.
H&E,
X400.

Figure 4.
H&E,
X400.

Figure 5.
Methenamine-silver
stain, X400.

Figure 6.
H&E,
X200.

Figure 7.
Immunofluorscence
for kappa light chains, X400.

Figure 8.
Immunofluorscence
for lambda light chains, X400.

Figure 9.
Immunofluorscence
for IgM, X400. Mild focal
segmental staining.

Figure 10.
Immunohistochemistry
(peroxidase) for kappa light chains, X400.

Figure
11.
Immunohistochemistry
(peroxidase) for lambda light chains, X400.

Figure 12.
Electron
microscopy, X2,000.

Figure 13.
Electron
microscopy, X3,000.

Figure 14.
Electron
microscopy, X6,000.
Immunofluorescence for IgA, IgG, C3,
and C1q: Negative. Congo red: Negative
What is your diagnosis?
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diagnosis and discussion
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