CASE 170 (April 2020)
A 25-year-old woman presents with edemas and foamy urine, 3 weeks of evolution. She does not report a pathological personal history. In system review there are no other alterations. On physical examination: only edema, no hypertension, no skin or mucosal changes.
Paraclinical: Hb: 13 mg/dL, Hto.: 40%, leukogram and platelets: normal. Serum albumin: 2.1 g/dL, Proteinuria: 9.7 g/24h. Urinary sediment with 8-10 erythrocytes/hpf, leukocytes 5/hpf, without casts. ANA: 1:160, anti-DNA: 1:10. C3: 85 mg/dL (90-180), C4: 10.2 mg/dL (10-40). Tests for viruses: negative.
See the images of the kidney biopsy.
Figure 1. H&E, X400. Note thickened, granular-looking, and highly eosinophilic capillary walls.
Figure 2. H&E, X400.
Figure 3. Masson's trichrome stain, X400.
Figure 4. Masson's trichrome stain, X400.
Figure 5. Methenamine-silver stain, X400. Capillary walls and mesangium without evident alterations.
Figure 6. Masson's trichrome stain, X1,000. Where are the fuschinofílic deposits located? .
Figure 7. Masson's trichrome stain, X1,000.
Figure 8. Methenamine-silver stain, X1,000. Note the projections on the outside of the glomerular basement membranes.
Figure 9. Direct immunofluorescence for IgG, X400.
Figure 10. Direct immunofluorescence for IgM, X400.
Figure 11. Direct immunofluorescence for C3, X400.
Figure 12. Direct immunofluorescence for C1q, X400.
Direct immunofluorescence for IgA: Negative.
What is your diagnosis?