PATIENT HISTORY:

The patient was a 68 year old normotensive, non-diabetic man with chronic renal insufficiency, congestive heart failure related to non-ischemic left ventricular dysfunction (previously treated with enalopril) and diarrhea (endoscopically negative, treated with imodium) who presented with nephrotic range proteinuria (4 gm/24 hrs) and minimal edema. There were no additional medications. Pertinent labs included: creatinine 1.8-2.0 mg%, ANA- negative, rheumatoid factor- negative, cryoglobulin screen- negative, hepatitis A/B/C serologies-negative, complements- normal, urine sediment-granular casts and oval fat bodies.

GROSS DESCRIPTION

MICROSCOPIC DESCRIPTION

IMMUNOFLUORESCENCE

ELECTRON MICROSCOPY

FINAL DIAGNOSIS