CASE 217 (March 2024)

Clinical information

A 36-year-old man with a history of abdominal surgery with extensive small bowel resection for a gunshot wound a year earlier is evaluated for edema and general malaise. In paraclinical Hct 36%, Hb 12.5 mg/dL, normal leukogram and platelets, serum creatinine 4.9 mg/dL, BUN 62 mg/dL, urinalysis with proteinuria 30 mg/dL, sediment without hematuria, leukocyturia, casts or reported crystals. Renal ultrasound with increased echogenicity, with preserved corticomedullary relationship, without hydronephrosis, calcifications or stones.

There are no findings in the interrogation and clinical and paraclinical evaluation that allow determining the etiology of renal failure.

With a diagnosis of acute kidney injury of unknown origin, a kidney biopsy is performed. Look at the images.

Figure 1. H&E, X100.

Figure 2. H&E, X200.

Figure 3. H&E, X400.

Figure 4. H&E, X400.

Figure 5. H&E, X400.

Figure 6. H&E, X400.

Figure 7. H&E, X400.

Figure 8. H&E, polarized light, X200.

Figure 9. H&E, polarized light, X200.

Figure 10. H&E, polarized light, X200.

Figure 11. H&E, polarized light, X400.

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