Case 79
With discussion
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CASE 79 (September 2012)

Clinical information

The patient is an infant of 9 months of age, female, without medical history and no family history of kidney disease. Seemingly sudden onset of nephrotic syndrome with generalized edema, hypoalbuminemia, dyslipidemia, and proteinuria of 120 mg/m2/hora.

Product of the first pregnancy, in which there were no complications, deliver at term. Normal growth and development. Except for the edema, physical examination was normal.

Serum creatinine: 0.3 mg/dL. Tests for hepatotropic virus, HIV and syphilis were negative. CBC and serum complement were normal. Urinalysis without casts or hematuria.

After two months of treatment with steroids, without response, a renal biopsy is undertaken. Creatinine had risen to 0.7 mg / dL.

See the images.

Figure 1. H&E, X200.

Figure 2. Masson's trichrome stain, X200.

Figure 3. H&E, X400.

Figure 4. H&E, X400.

Figure 5. Masson's trichrome stain, X400.

Figure 6. Masson's trichrome stain, X400.

Figure 7. Methenamine-silver stain, X400.

Figure 8. Methenamine-silver stain, X400.

Figure 9. Methenamine-silver stain, X400.

Figure 10. Immunofluorscence for IgM, X200.

Figure 11. Immunofluorscence for C3, X400.

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

What is your diagnosis?

See diagnosis and discussion