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CASE 151 (September 2018)

Clinical information

The patient is a 4-year-old girl with no pathological personal history, normal growth and development, and complete vaccination. History of 3 months of intermittent edema, without other symptoms. There is no family history of kidney diseases.

In the laboratory, nephrotic proteinuria is documented: 65 mg/m2/h, serum creatinine: 0.9 mg/dL, BUN; 17 mg/dL. Microhematuria, few waxy casts. ANA, anti-DNA and ANCA: Negative. C3: 81 (90-180), C4: 14 (10-40). Studies for hepatotropic viruses and HIV: Negative. Normal AELOs and negative hemoparasites.

At the physical examination: High systemic blood pressure, edema in the lower limbs, no skin lesions. No other alterations.

See the images of the renal biopsy.

Figure 1. H&E, X100.

Figure 2. H&E, X400.

Figure 3. H&E, X400.

igure 4. H&E, X400.

Figure 5. Masson's trichrome, X400.

Figure 6. PAS, X200.

Figure 7. Methenamine-silver, X400.

Figure 8. Methenamine-silver, X400.

Figure 9. Direct immunofluorescence fof IgG, X400.

Figure 10. Direct immunofluorescence fof IgM, X400.

Figure 11. Direct immunofluorescence fof C3, X400.

Figure 12. Direct immunofluorescence fof C1q, X400.

Figure 13. Direct immunofluorescence fof kappa light chain, X400.

Figure 14. Direct immunofluorescence fof lambda light chain, X400.

Figure 15. EM, original magnification, X4,000.

Figure 16. EM, original magnification, X2,500.

Figure 17. EM, original magnification, X2,500.

IF for IgA: Negative.

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