Case
31 With discussion |
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Versión
en Español |
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CASE 31 (September 2008)
Clinical information
The patient is a 34-year-old woman. She has HIV infection diagnosed at 24-year-old age. At 33-year-old, in the 26th week of her first pregnancy, nephrotic syndrome was diagnosed. Proteinuria up to 6.2 g/24h, urine erythrocytes: 5 / HPF; serum creatinine 0.9 mg/dL. Mild systemic blood pressure increase. Patient continues with symptomatic managment. Her pregnancy ends without maternal or fetal complications.
Three months after childbirth the nephrotic syndrome continues. Normal renal function. Serum complement: normal. ANAs, ANCAs, Anti-DNA: negative. Hepatitis B and C viruses: negative. There is not AIDS. Lymphocytes: >1,000/mm3. There is not report of other laboratory tests in her clinical history.
A renal biopsy is carried out. See the images.
Figure 1. H&E, X100.
Figure 2. H&E, X400.
Figure 3. Masson's trichrome stain, X400.
Figure 4. Methenamine-silver stain, X400.
Figure 5. PAS stain, X400.
Figure 6. Direct immunofluorescence using antiserum to IgA, X400.
Figure 7. Direct immunofluorescence using antiserum to IgG, X400.
Figure 8. Direct immunofluorescence using antiserum to IgM X400.
Figure 9. Direct immunofluorescence using antiserum to C3, X400.
Figure 10. Direct immunofluorescence using antiserum to C1q, X400.
What is your diagnosis?