CASE 132 (February 2017)
The patient is a 63-year-old woman with no known medical history. She presented with general malaise, headache, and weakness. In paraclinical tests: Hb: 7.8 mg/dL, hematocrit: 23%, platelets: 280,000. Serum creatinine 3.8 mg/dL that increased to 5.2 mg/dL one week later, BUN 59 mg/dL. ANA, anti-DNA and ANCA: Negative. Studies for hepatotropic viruses and HIV: Negative. Normal complement. Urinalysis: Proteinuria: 100 mg/dL, erythrocyte: 20/HPF, leukocytes: 10/HPF, presence of waxy and granular casts.
Physical examination: PA: 145/90. Mucocutaneous pallor. No skin lesions. No megalias. No other alterations.
A kidney biopsy was done. See the images.
Figure 1. H&E, X100.
Figure 2. H&E, X400.
Figure 3. Masson's trichrome stain, X400.
Figure 4. H&E, X400.
Figure 5. H&E, X400.
Figure 6. H&E, X400.
Figure 7. H&E, X400.
Figure 8. Masson's trichrome stain, X400.
Figure 9. Direct immunofluorescence for lambda light chains, X400.
Figure 10. Direct immunofluorescence for kappa light chains, X400.
Direct immunofluorescence for IgA, IgG, IgM, C3 and C1q: Negative.
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