CASE 72 (February 2012)
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?