Case
104 With discussion |
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CASE 104 (October 2014)
Clinical information
The patient is a 62-year-old man. Four months of weight loss (7 kg), lower limb edema, mild dyspnea and foamy urine. Physical examination found no skin lesions and no neurological abnormalities.
Lab: Hb 7.9 mg/dL, hematocrit 23%, platelet count: 186,000 creatinine 2.3 mg/dL, BUN 72 mg/dL. Urinalysis: Proteinuria 5 g/24h; sediment: erythrocytes 3/HPF, leukocytes 10/HPF, cylinders not observed. Total cholesterol 250, triglycerides 180, Albumin 2.9 g/dL. PTH 55 pg/ml. Serum calcium 10.4 mmol/L.
A renal biopsy was performed. See the microscopic images.
Figure 1. Masson's trichrome stain, X200.
Figure 2. H&E, X400.
Figure 3. H&E, X400.
Figure 4. H&E, X400.
Figure 5. H&E, X200.
Figure 6. Masson's trichrome stain, X200.
Figure 7. Masson's trichrome stain, X400.
Figure 8. PAS, X400.
Figure 9. Masson's trichrome stain, X400.
Figure 10. Methenaime-silver stain, X400.
Figure 11. Congo red; right: polarized, X400.
Figure 12. Immunohistochemistry for kappa (left) and lambda (right), X400.
What is your diagnosis?