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
A 12-year-old boy is brought to an outpatient clinic by his mother, who noticed that her son’s urine has been dark for the past 4 days. She initially attributed this to inadequate hydration, so she monitored her son’s fluid intake and encouraged him to drink more water. However, she noticed that the color of the urine kept getting darker until it began to resemble cola. The boy’s medical history is significant for a sore throat approx. 2 weeks ago, which resolved without medication or treatment. The boy has also been complaining of pain in his ankles, which he first noticed shortly after soccer practice 1 week ago. He has had no pain during urination or urethral discharge, however, and does not have any history of previous episodes of cola-colored urine or passage of blood in the urine. However, the boy has been experiencing intermittent episodes of abdominal pain for the past 3 days. The boy also has wheals on his torso, legs, and buttocks, which his mother attributes to seasonal allergies. Physical examination reveals an alert child who is not in obvious distress but who has a mild conjunctival pallor. Vital signs include: respiratory rate is 22/min, temperature is 36.7°C (98.0°F), and blood pressure is 130/90 mm Hg. Examination of the musculoskeletal system reveals multiple skin lesions (see image). Which of the following laboratory findings is most likely associated with this patient’s clinical presentation?
AElevated level of serum IgA
BElevated IgM-IgG immune complex rheumatoid factor
C24-hour urinary protein of more than 4 g
DElevated levels of serum IgG and C3 protein
ELow C-reactive protein level
A 61-year-old man comes to the physician because of progressively worsening swelling of his ankles. He says he has felt exhausted lately. Over the past 3 months, he has gained 5 kg. He has smoked one pack of cigarettes daily for 30 years. His pulse is 75/min and his blood pressure is 140/90 mmHg. Examination shows 2+ pitting edema in the lower extremities. Neurologic exam shows diminished two-point discrimination in the fingers and toes. A urine sample is noted to be foamy. Laboratory studies show a hemoglobin A1c of 7.9% and creatinine of 1.9 mg/dL. A biopsy specimen of the kidney is most likely to show which of the following?
ANodular glomerulosclerosis
BWire looping of capillaries
CImmune complex deposition
DSplit glomerular basement membrane
EInterstitial inflammation
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