CASE 182 (April 2021)

Clinical information

A 61-year-old man, with a history of long-standing non-insulin-requiring diabetes mellitus, presented recurrent urinary symptoms, with a diagnosis of recurrent urinary tract infection. Elevation of serum creatinine is now detected: 1.7 mg / dL, BUN: 28 mg / dL. Proteinuria: 2.1 g / 24 h. Studies of autoimmunity and viral infections were negative. Urinary sediment with abundant leukocytes and erythrocytes, positive urine culture for E. coli. On ultrasound, the left kidney is enlarged, with hydronephrosis, without corticomedullary differentiation, and on scintigraphy there is functional exclusion of this kidney. The right kidney is functional, but with poorly defined, "solidified" areas on ultrasound.

Nephrectomy of the left kidney is done. Look at the pictures.

Figure 1.

Figure 2. H&E, X400.

Figure 3. H&E, X100. Extensive areas of fibrosis and lymphohistiocytic infiltrate.

Figure 4. H&E, X400. Try to identify intracytoplasmic basophilic inclusions.

Figure 5. H&E, X400. Again, identify basophilic inclusions.

Figure 6. PAS, X400.

Figure 7. PAS, X400.

Figure 8. Von Kossa stain, X400.

What is your diagnosis?

See diagnosis and discussion

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