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CASE 142 (December 2017)

Clinical information

The patient is a 57-year-old woman with edemas of recent onset. No pathological personal history. She does not report previous episodes of infection. No family history of kidney disease. At the physical examination: edema in the lower limbs and arterial hypertension: 150/95 mm/Hg. No other alterations.

Laboratory: Hb: 12 mg/dL, Ht: 37%, platelets and leukogram: normal. Serum creatinine: 1.54 mg/dL, BUN: 25 mg/dL, albumin: 2.9 g/dL. Uroanalysis: proteinuria 500 mg/dL, 9 g in 24 hours, microhematuria. ANA, anti-DNA and ANCA: Negative. C3: 64 (90-10), C4: 22 (10-40). Studies for viruses: negative.

Look at the images.

Figure 1. H&E, X100.

Figure 2. H&E, X400.

Figure 3. H&E, X400.

Figure 4. PAS, X400.

Figure 5. Masson's trichrome stain, X400.

Figure 6. Masson's trichrome stain, X400.

Figure 7. Methenamina-silver stain, X400.

Figure 8. Methenamina-silver stain, X400.

Figure 9. Direct immunofluorescence por IgG, X400.

Figure 10. Direct immunofluorescence por C3, X400.

Figure 11. Direct immunofluorescence por kappa light chain, X400.

Figure 12. Direct immunofluorescence por lambda light chain, X400.

Immunofluorescence for IgA, IgM, and C1q: Negative.

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