Case 99
With discussion
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CASE 99 (May 2014)

Clinical information

The patient is a 27-year-old man with a history of several episodes of macroscopic hematuria in the last year, with persistent microscopic hematuria and mild proteinuria in several urinalysis. A renal biopsy was requested, however, it was not done due to social and economic difficulties. The patient consults the doctor for a week of edema, malaise, subjective fever and flu symptoms.

In laboratory tests: creatinine 2.8 mg/dL (0.9 mg/dL three months before). Urinalysis: RBC: 50-60 per high power field (HPF), leukocytes: 5-7/HPF, proteinuria 300 mg/dL, 2.2 g/24h. Studies of autoimmunity: negative; serum complement: normal. Test for viruses: negative.

No other medical history and no known family history of renal disease. At physical examination edema in lower limbs and mild facial edema. BP: 150/90, no fever, no skin lesions. No other alterations.

A renal biopsy was carried out. See the images:

Figure 1. H&E, X100.

Figure 2. H&E, X200.

Figure 3. H&E, X400.

Figure 4. H&E, X400.

Figure 5. PAS, X400.

Figure 6. Masson's trichrome stain, X400.

Figure 7. Masson's trichrome stain, X200.

Figure 8. Masson's trichrome stain, X400.

Figure 9. Methenamine-silver stain, X200.

Figure 10. Masson's trichrome stain, X400.

Figure 11. Direct immunofluorescence for IgA, X400.

Figure 12. Direct immunofluorescence for C3, X400.

Immunofluorescence for IgG, IgM, C1q: Negative.

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