A 12-year-old boy is found on a routine auditory screening to have mild high frequency hearing impairment. On exam, he has no ear pain, no focal neurological deficits, and no cardiac murmurs. He has not had any recent illness. Laboratory studies show: Serum: Creatinine: 0.7 mg/dl Protein: 3.8 g/dl Antistreptolysin O titer: 60 Todd units (12-166 normal range) Urinalysis: Microscopic heme Protein: 4+ RBCs: 6/hpf A kidney biopsy is taken. Which of the following findings is most characteristic of this patient’s disease?
AThickened “tram-track” appearance of basement membrane on electron microscopy
B“Spike and dome” appearance on electron microscopy
CCrescent-moon shapes on light microscopy
DLarge eosinophilic nodular lesions on light microscopy
E“Basket-weave” pattern of basement membrane on electron microscopy
A 22-year-old man comes to the physician because of a 2-week history of cough and decreased urination. The cough was initially nonproductive, but in the last few days he has coughed up small amounts of blood-tinged sputum with clots. He has not had any fevers, chills, or weight loss. He has smoked one pack of cigarettes daily for 5 years. Pulse is 115/min and blood pressure is 125/66 mm Hg. Physical examination shows dried blood around the lips. Serum studies show a creatinine of 2.9 mg/dL. Results of a serum antineutrophil cytoplasm antibody test are negative. A biopsy specimen of the kidney is most likely to show which of the following light microscopy findings?
AThinning of the basement membrane
BFibrin crescents in Bowman space
CExpansion of the mesangial matrix
DEnlarged and hypercellular glomeruli
ENeutrophilic infiltration of the capillaries
A 21-year-old male presents to your office with hematuria 3 days after the onset of a productive cough and fever. Following renal biopsy, immunofluorescence shows granular IgA deposits in the glomerular mesangium. Which of the following do you suspect in this patient?
ALipoid nephrosis
BBerger’s disease
CHIV infection
DSystemic lupus erythematosus
EPoststreptococcal glomerulonephritis
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