PERPLEXING RENAL BIOPSY  

CASE HISTORY

•        32 yrs old male non  hypertensive, non-diabetic

•        Coryza 1 month back

•        Puffiness of face 15 days

•        Detected to have proteinuria hence referred

Examination

•        Vitals normal

•        No edema

•        Minimal puffiness

•        Systemic normal

Investigations

•        Hb – 12.9 gm/dl

•        Urea – 15 mg/dl

•        Creatinine – 1.0 mg/dl

•        Cholesterol – 259 mg/dl

•        Protein creatinine ratio – 10.5

•        Urine routine – pus cells 2-3/hpf, epithelial cells – 5-6 / hpf

Picture 1 H & E stain

Biopsy includes 19 glomeruli of which 12 – 13 glomeruli are enlarged in size & show segmental areas of increase in mesangial matrix.

Picture 2 PAS stain

The glomeruli show intracapillary deposits. These deposits are obliterating the capillary lumina & are eosinophilic, PAS negative.

Picture3 SILVER stain

•        The glomeruli show intracapillary deposits Which are silver negative.

•        The basement membrane is thin and not split.

Picture4 TRICHROME stain

These deposits are blue on Masson’s Trichrome – These deposits are not fuchsinophilic hence not collagen.

Congo red : Reported as negative.

Immunofluorescence Study   :-   03  Glomeruli are  included in the biopsy.

•        IgG      :          Negative

•        IgM     :           Negative

•        IgA      :          Negative

•        C3        :          Negative