In December 2004, a 17-year-old Caucasian male patient with a history of hepatitis at 3 years of age was referred to the Nephrological Polyclinic of the Hospital de Clínicas de Monteo for examination of isolated proteinuria.
The presence of foamy urine, edema or decreased urine output was ruled out in the interview.
Physical examination was normal, with blood pressure of 120/70 mmHg.
Laboratory tests: proteinuria of 2.2 g/1, selective, with 80% albumin, non-microhematuria, creatininemia of 0.89 mm/dl, azoemia: 0.12 g/9 globulin dl; albuminemia:
Antinuclear antibodies (ANA) and anti-DNA were negative on two occasions.
Hepatic enzyme: BT 0.82 mg/ di, TGO 22, TGP 15, FA 2.26, andGT 28 (Ul/lt).
Complementemia was normal.
Serology for ANCA and HIV, hepatitis C and B virus was negative.
Renal and abdominal ultrasound was normal.
The patient received enalapril (40 mg/day) associated with losartan (50 mg/day).
The patient presented progressive remission of proteinuria, which was total 18 months after starting treatment.
Renal function remained normal.
With the establishment of an EFS, a renal biopsy was performed for histopathological examination with luminal tape (ML), computerized physician (ME) and immunofluorescence (IF).
Histopathology.
A total of 20 glomeruli were observed, 1 of which had a higher incidence and 50% of the glomerulus area, while 4 showed mild glomerular segmentation, moderate increase in the mesangial capsule and non-glomerular segmentation.
Few juxtaposed juxta-tamesangial philosophies deposits were found with the trichrome compound.
The tubulointerstitial sector showed a small focus of tubular necrosis and some cylinders with crenated erythrocytes.
The arteries were normal.
Immunofluorescence.
Positivity was detected for Clq +++, dominant; IgA++ perihilar; IgG, IgM, C3 positive++, with thick granular pattern, predominantly fibrinogen mesangial distribution:
Micr electronics.
Pedal flattening was observed in less than 20% of the surface of the capillary loops, electrondense granular paramesangial deposits in the region where the basal glomerular membrane (MBG) and moderate glomerular fibers were reflected.
Glomerular capillary endothelium showed no tubular reticular inclusions (ITR).
