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CASE 173 (July 2020)

Clinical information

A 59-year-old woman with a history of metastatic gastrointestinal stromal tumor, undergoing chemotherapy, presented with edema and an increase in creatinine: 1.7 mg / dL. Complete nephrotic syndrome was documented; , proteinuria 6.2 g/24h, dyslipidemia and hypoalbuminemia. Renal ultrasound: kidneys of normal size, with decreased corticomedullary differentiation, without obstruction. Autoimmunity, infection and paraprotein studies: negative or normal.

Kidney biopsy is done. Look at the photomicrographs.

Figure 1. Masson's trichrome stain, X100.

Figure 2. H&E, X400.

Figure 3. H&E, 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. Methenamine-silver stain, X200.

Figure 9. H&E, X400.

Figure 10. Masson's trichrome stain, X200.

Figure 11. EM, original magnification, X2,100.

Figure 12. EM, original magnification, X2,100.

Figure 13. EM, original magnification, X1,500.

Direct immunofluorescence for IgA, IgG, IgM, C3, C1q, kappa, and lambda: Negative.

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