Case 414 Medical history 12-year old male patient with complaints of “coca-cola” colored urine for a week. Mother reports previous viral infection and said that she had seen his urine like this before. Denied fever or pain. Child and parents are healthy. Passed uncle underwent renal replacement therapy. On physical examination: hydrated, anicteric, acyanotic, with normal color. HR: 90 bpm, RR: 18 br/min, BP: 100x70 mmHg, without edema. Urine exam showed dysmorphic red blood cells. Total cholesterol and fractions, albumin and complement within the reference range. ALSO, FAN and Anti-dsDNA negative. Renal biopsy was requested. Image 1: Renal histological section under optical microscopy. PAS staining.Image 2: Glomerular scanning electron microscopy.Image 3: Renal histological section with direct immunofluorescence technique. Question:Considering the clinical case and presented images, what is the most likely diagnosis? IgA nephropathy Lupus nephritis Minimal change disease Post-steptococcal glomerulonephritis Time is Up! Time's up
