Case
211 With discussion |
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Versión
en Español |
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CASE 211 (September 2023)
Clinical information
A 48-year-old woman is evaluated in the nephrology clinic for chronic kidney disease without a clear etiology. Multiple studies for autoimmunity, infections, or monoclonality were negative. As background, she reports arterial hypertension and hyperuricemia diagnosed 5 years ago, under treatment with ACE inhibitors and allopurinol.
Laboratory: Hb. 10, hto. 29, normal platelets and leukogram. Serum creatinine: 2.2 mg/dL, BUN: 39 mg/dL, uric acid: 9.8 mg/dL. Urinalysis: proteinuria 100 mg/dL, in the sediment: 3-4 leukocytes/hpf, erythrocytes: 3/hpf, waxy casts. Normal serum albumin. Normal protein electrophoresis.
Renal biopsy was done. See the images.
Figure 1. Masson's trichrome stain, X100.
Figure 2. Masson's trichrome stain, X200.
Figure 3. H&E, X400.
Figure 4. Masson's trichrome stain, X400.
Figure 5. Methenamine-silver stain, X200.
Figure 6. H&E, X400.
Figure 7. Masson's trichrome stain, X200.
Figure 8. Masson's trichrome stain, X400.
Figure 9. Masson's trichrome stain, X400.
Figure 10. Methenamine-silver stain, X200.
Direct immunofluorescence for IgA, IgG, IgM, C3, C1q, kappa, and lambda: Negative.
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