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 43-year-old man comes to the physician for a 1-week history of swelling around his eyes and decreased urination. His pulse is 87/min, and blood pressure is 152/95 mm Hg. Physical examination shows 1+ periorbital and pretibial edema. Serum studies show a urea nitrogen concentration of 21 mg/dL and a creatinine concentration of 1.4 mg/dL. Urinalysis shows 3+ blood and 1+ protein. Further evaluation of this patient is most likely to show which of the following?
AUrinary rhomboid crystals
BRenal interstitial inflammation
CHypoalbuminemia
DDetached renal tubular epithelial cells
ERed blood cell casts
A 45-year-old man presents with a 3-day history of right-sided flank pain due to a lodged ureteral stone. What changes would be expected to be seen at the level of glomerular filtration?
AIncrease in glomerular capillary oncotic pressure
BIncrease in Bowman's space oncotic pressure
CIncrease in filtration fraction
DIncrease in Bowman's space hydrostatic pressure
ENo change in filtration fraction
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