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CASE 156 (February 2019)

Clinical information

A 28-year-old man is evaluated for presenting isolated, mild and persistent proteinuria. As a relevant antecedent, the patient suffered an ophidic accident 2 years earlier, presented sepsis and acute kidney injury, with creatinine reaching 3.8 mg/dL, without needing dialysis; also, at that time, he presented transient C3 hypocomplementemia; the renal alterations resolved days later normalizing creatinine and complement. A biopsy could not be done due to the patient's general conditions. There are no other pathological antecedents prior to the ophidic accident.

Since then, he has presented persistent mild proteinuria, with normal renal function and no hematuria. The proteinuria has varied between 250 mg/24h and 540 mg/24h; last: 520 mg/24h. Normal serum complement; negative autoimmunity studies. Tests for infectious diseases; negative.

See the images of the renal biopsy.

Figure 1. PAS, X400.

Figure 2. PAS, X400.

Figure 3. H&E, X400.

Figure 4. Masson's trichrome stain, X400.

Figure 5. Masson's trichrome stain, X400.

Figure 6. Methenamine-silver, X400.

Figure 7. EM, original magnification X2,100.

Figure 8. EM, original magnification X2,100.

Figure 9. EM, original magnification X2,100.

Figure 10. EM, original magnification X2,100.

Figure 11. EM, original magnification X2,100.

Figure 12. EM, original magnification X2,100.

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

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