CASE
83 (January 2013)
Clinical information
The patient is a girl, 12 years old,
with no medical history. Twenty days of evolution of facial edema subsequently
accompanied by leg edema, malaise and hyperpigmented urine. On physical
examination there is also high blood pressure: 145/90.
Laboratory: The CBC shows mild normocytic
normochromic anemia. Tests for viruses: negative. ANA and ANCA: negative.
C3 89 (90-180) and C4 36 (10-40). Serum creatinine: 1.2 mg/dL and BUN:
31 mg/dL. Proteinuria in 24 hours: 2.3 g (73 mg/m2/h), with mild hypoalbuminemia.
Urinalysis: 20-30 erythrocytes and 3-4 leukocytes per HPF. Tryglicerides:
217 mg/dL and total cholesterol: 384 mg/dL.
See the images of the renal biopsy.
Figure 1.
H&E, X100.
Figure 2.
H&E, X200.
Figure 3.
H&E,
X400.
Figure 4.
PAS,
X400.
Figure 5.
Methenamine-silver
stain, X400.
Figure 6.
Masson's
trichrome stain,
X1,000.
Figure 7.
Masson's
trichrome stain,
X1,000.
Figure 8.
Immunofluorscence
for IgG, X400.
Figure 9.
Immunofluorscence
for C3, X400.
Direct immunofluorescence for
IgA, IgM, C1q, kappa, and lambda: Negative.
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