Case 82
With discussion
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CASE 82 (December 2012)

Clinical information

The patient is a 17-year-old woman with no medical history, who consults for edema in legs and malaise. She presents mild hypertension, but no other abnormalities on physical examination.

Paraclinical: Hct: 38%, Hb: 12.1 mg/dL, platelet 280,000, Normal leukogram. ANA and anti-DNA negative. C3: 63 (90-180), C4: 18 (10-40). Tests for viruses: negative. Serum creatinine: 1.6 mg/dL, BUN 42 mg/dL, creatinine clearance: 34 mL/min. Urinalysis: proteins: 300 mg/dL, 8-10 erythrocytes/HPF, without casts. Proteinuria in 24 hours: 2.9 g.

A renal biopsy is undertaken: in histologic sections there are only two glomeruli; there are not tubulointerstitial alterations. See the images.

Figure 1. H&E, X400.

Figure 2. H&E, X400.

Figure 3. PAS, X400.

Figure 4. Masson's trichrome stain, X400.

Figure 5. Masson's trichrome stain, X400.

Figure 6. Methenamine-silver stain, X400.

Figure 7. Methenamine-silver stain, X400.

Figure 8. Immunofluorscence for C3, X400.

Figure 9. Immunofluorscence for C3, X400.

Direct immunofluorescence for IgA, IgG, IgM, C1q, kappa, and lambda: Negative.

What is your diagnosis?

See diagnosis and discussion