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CASE 171 (May 2020)

Clinical information

The patient is a 26-year-old man, with edema of the lower limbs for approximately 1 month. He reports occasional headache. There are no other antecedents. On physical examination, arterial hypertension was found: 145/90 and edema up to both ankles. No other alterations.

Paraclinical: Hb: 13.4 mg/dL, Hct: 41%, leukogram and platelets: normal. Serum creatinine: 1.5 mg/dL; BUN: 28 mg/dL. Proteinuria: 2.2 g/24h; serum albumin: 3.3 g/dL. Urinary sediment with 8-10 erythrocytes/hpf, leukocytes 2/hpf, without casts. ANAs and anti-DNA: negative, normal complement, virus studies: negative. There is no dyslipidemia.

See the images of the kidney biopsy.

Figure 1. H&E, X200.

Figure 2. H&E, X400.

Figure 3. H&E, X400.

Figure 4. H&E, X400.

Figure 5. PAS, X400.

Figure 6. Masson's trichrome stain, X1,000.

Figure 7. Methenamine-silver stain, X400.

Figure 8. Methenamine-silver stain, X400.

Figure 9. Direct immunofluorescence for IgA, X400.

Figure 10. Direct immunofluorescence for C3, X400.

Figure 11. EM, original magnification, X1,500.

Figure 12. EM, original magnification, X2,500.

Figure 13. EM, original magnification, X2,500.

Direct immunofluorescence for IgG, IgM and C3: Negative.

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