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CASE 221 (July 2024)

Clinical information

A 37-year-old man, with no known personal medical history, presents with nephrotic syndrome, edema of several months' duration, proteinuria: 7.9 g/24 hours, total cholesterol: 450 mg/dL, triglycerides: 580 mg/dL, albumin in serum: 2.6 g/dL, serum creatinine: 1.0 mg/dL, BUN: 14 mg/dL. Autoimmunity and virus studies: negative. There are no extrarenal alterations. He reported no family history of kidney disease.

Kidney biopsy is done. Look at the images.

Figure 1. H&E, X400.

Figure 2. H&E, X400.

Figure 3. H&E, X400.

Figure 4. H&E, X400.

Figure 5. Masson's trichrome stain, X400.

Figure 6. Methenamine-silver stain, X400.

Figure 7. Methenamine-silver stain, X400.

Figure 8. PAS, X400.

Figure 9. PAS, X400.

Figure 10. PAS, X400.

Direct immunofluorescence for IgA, IgG, IgM, C3, C1q, kappa, lambda, and fibrinogen: Negative.

What is your diagnosis?

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