Case 28
With discussion
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CASE 28 (June 2008)

Clinical information

The patient is a 13-year-old woman without pathologic personal antecedents. She is evaluated in our hospital due to facial and legs edema that started 18 days ago. She does not present other symptoms. No fever. Foamy urine. No macroscopic hematuria. The patient reported symptoms clinically compatible with tonsillopharyngitis approximately 10 days prior to the start of edema. There are not family antecedents of renal diseases.

On physical examination: Blood pressure 130/80, heart rate: 84 X', temperature: 37 ºC, facial and legs edema. No other alterations.

Hemoglobin: 11.7 mg/dL, hematocrit: 37%, Serum creatinine: 1.9 mg/dL, BUN: 39 mg/dL. ANAs, ANCAs, Anti-DNA: negative. A, B, and C hepatitis: negative. C3: 69 mg/dL (90-180); C4: 8 mg/dL (10-40). Total serum proteins: 5.2 g/dL (5.5-8.0); serum albumin: 3.3 g/dL (3.5-5.5). Serum proteins electrophoresis: normal. Proteinuria: 4.0 g/24h, urine erythrocytes: 50 HPF; erythrocytic, leukocytic, and granular casts.

The patient experiences during hospitalization malaise, fever and cough. A pleural effusion and pneumonic consolidation was detected in this same side.

What is your clinical diagnosis?

See the images of the biopsy.

Figure 1. H&E, X200.

Figure 2. H&E, X400.

Figure 3. Methenamine-silver stain, X400.

Figure 4. Masson's trichrome stain, X1,000.

Figure 5. Masson's trichrome stain, X1,000.

Figure 6. Direct immunofluorescence using antiserum to IgG, X400.

Figure 7. Direct immunofluorescence using antiserum to C3, X400.

Figure 8. Direct immunofluorescence using antiserum to C1q X400.

Direct immunofluorescence for IgA: traces in capillary walls.
Direct immunofluorescence for IgM: Negative.

What is your diagnosis?

See diagnosis and discussion