CASE 196 (June 2022)

Clinical information

A 27-year-old man, with no medical history, presents with edema of two weeks' duration, with no other symptoms. He reports foamy urine. On physical examination, generalized edema, dehydrated, BP: 120/80, HR: 76/minute, without respiratory alterations. Skin without lesions.

Paraclinical: Hb: 13 mg/dL, Hct: 39%, normal leukogram. Cr: 1.3/dL, BUN: 22/dL. Proteinuria: 8.6 g/24h, albumin in blood: 2.3 g/dL, dyslipidemia. ANAs and anti-DNA: negative, C3: 114 mg/dL, C4: 19 mg/dL. Studies for hepatotropic viruses and HIV were negative. In urine sediment: leukocytes: 2-3/CGA, erythrocytes 3/CGA.

Renal biopsy is done, look at the images:

Figure 1. H&E, X400. Segmental lesions with endocapillary hypercellularity.

Figure 2. H&E, X400.

Figure 3. H&E, X400. The lesions are segmental and only evidenced in some glomeruli.

Figure 4. Masson´s trichrome stain, X400.

Figure 5. Masson´s trichrome stain, X400.

Figure 6. Masson´s trichrome stain, X400. Segmental sclerosing lesion.

Figure 7. H&E, X400.

Figure 8. Methenamine-silver stain, X400.

Figure 9. Methenamine-silver stain, X400.

Figure 10. Methenamine-silver stain, X400, X400.

Figure 11. PAS, X400.

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

Figure 13. Direct immunofluorescence for IgM, X400. Segmental positivity oinly in one of 5 glomeruli.

Figure 14. Direct immunofluorescence for C3, X400. Segmental positivity in the same glomerulus that was positive for IgM.

Immunofluorescence for IgA, IgG, and C1q: negative.

What is your diagnosis?

See diagnosis and discussion

[Top]