CASE 72 (February 2012)

Clinical information

A 43-year-old man presented with nephrotic syndrome; progressive edema for about 2 months. Proteinuria in 24 hours: 13.3 g. His serum creatinine was 3.4 mg/dL, BUN 87 mg/dL. Hb: 10.2 mg/dL, hematocrit: 31%. Leucogram and platelets were normal. Complement level was normal. ANAs and ANCAs were negative. HIV and hepatotropic viruses were negative. Serum protein electrophoresis was normal.

Personal history: No hypertension, no diabetes. Psoriasis for about 5 years. No relevant family history.

A renal biopsy was undertaken. See the images.

Figure 1. H&E, X100.

Figure 2. H&E, X100.

Figure 3. Methenamine-silver stain, X100.

Figure 4. H&E, X400.

Figure 5. Masson's trichrome stain, X400.

Figure 6. Masson's trichrome stain, X400.

Figure 7. PAS, X400.

Figure 8. Methenamine-silver stain, X400.

Figure 9. Methenamine-silver stain, X400.

Figure 10. H&E, X400.

Figure 11. Methenamine-silver stain, X400.

Immunofluorescence for IgA, IgG, C3, C1q, kappa, and lambda: Negative. Mild focal and segmental positivity for IgM.

What is your diagnosis?

Would you order other ancillary studies in tissue biopsy?

See diagnosis and discussion

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