CASE 161 (July 2019)
A 67-year-old woman is evaluated for having purpura in lower extremities, as well as arthralgias in the hands, lower limb edema, and malaise. She also presents hypertension, elevation of cretinine and mild normocytic, normochromic anemia.
Paraclinical: Hb: 10.9 mg/dL, Hto: 33%, platelets: 220,000/mm2, normal leukogram. Serum Cratinin: 2.1 mg/dL, BUN: 42 mg/dL; C3: 87 mg/dL (90-180), C4: 2.4 mg/dL (10-40). ANA, anti-DNA and ANCA: negative. Proteinuria: 2.2 g/24h. Urinary sediment with erythrocytes: 40/hpf, and leukocytes: 10/hpf.
See the images of the renal biopsy.
Figure 1. H&E, X100.
Figure 2. H&E, X400.
Figure 3. Masson's trichrome stain, X400.
Figure 4. Masson's trichrome stain, X400.
Figure 5. Methenamine-silver stain, X400.
Figure 6. Methenamine-silver stain, X400.
Figure 7. Methenamine-silver stain, X400.
Figure 8. Masson's trichrome stain, X200.
Figure 9. Methenamine-silver stain, X400.
Figure 10. Direct immunofluorescence for IgG, X400.
Figure 11. Direct immunofluorescence for IgM, X400.
Figure 12. Direct immunofluorescence for C3, X400.
Figure 13. Direct immunofluorescence for C1q, X400.
Figure 14. Direct immunofluorescence for kappa, X400.
Figure 15. Direct immunofluorescence for lambda, X400.
Direct immunofluorescence for IgA: Negative.
What is your diagnosis? Do you suggest other laboratory tests?