CASE 188 (October 2021)

Clinical information

A 65-year-old man undergoes abdominal aortic aneurysm correction surgery, a procedure without intraoperative complications. Three days later, he presented elevated serum creatinine from a baseline of 1.4 to 3.8 mg/dL, BUN 64 mg/dL, proteinuria: 60 mg/dL, with microhematuria. He has a history of dyslipidemia and chronic high blood pressure. Autoimmunity and virus studies: negative. Protein electrophoresis: normal. The patient is considered to have exacerbated chronic kidney disease.

A kidney biopsy was performed. See the pictures.

Figure 1. H&E, X200. Acute tubular damage.

Figure 2. Masson's trichrome stain, X200.

Figure 3. H&E, X400. Normal glomerulus.

Figure 4. Masson's trichrome stain, X400.

Figure 5. H&E, X400.

Figure 6. H&E, X200. What is in the lumen of the artery?

Figure 7. Masson's trichrome stain, X200. See de lumen of the artery.

Figure 8. Methenamine-silver stain, X200.

Figure 9. H&E, X400. A small artery/arteriole with similar abstruction.

Figure 10. Masson's trichrome stain, X400.

Figure 11. Masson's trichrome stain, X400. Some glomerular ischemic changes.

Figure 12. Methenamine-silver stain, X400. Bloodless glomerulus.

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

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