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CASE 159 (May 2019)

Clinical information

A 38-year-old woman, HIV positive for 6 years, is evaluated due to generalized edema. Nephrotic syndrome, increased cretinine and systemic hypertension are documented. Proteinuria: 13 g/24h, microhematuria, multiple casts in the urinary sediment. Serum creatinine: 2.4 mg/dL. Normal C3 and C4 serum levels. Tests for hepatotropic viruses: Negative. Pulmonary histoplasmosis was also documented.

She has irregularly received antiretroviral therapy. Number of copies of HIV RNA in plasma: 600,000/mL. CD4 count: 40/mm3.

See the images of the renal biopsy.

Figure 1. Masson's trichrome stain, X200.

Figure 2. H&E, X400.

Figure 3. PAS, X200.

Figure 4. Masson's trichrome stain, X400.

Figure 5. Masson's trichrome stain, X400.

Figure 6. Masson's trichrome stain, X400.

Figure 7. Methenamine-silver stain, X400.

Figure 8. Methenamine-silver stain X400.

Figure 9. Methenamine-silver stain, X400.

Figure 10. Methenamine-silver stain, X4.00.

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

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