Case 85
With discussion
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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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