A 5-Year-Old Boy Is Brought to the Office with Generalized

A 5-year-old boy is brought to the office with generalized edema that developed following a mild upper respiratory infection.  Medical history is unremarkable.  Blood pressure and heart rate are normal.  Serum creatinine levels are normal.  Urinalysis shows massive proteinuria with no hematuria.  Further analysis reveals that urine protein consists principally of albumin with only trace amounts of IgG and alpha-2-macroglobulin.  Which of the following pathologic changes is the most likely cause of this patient's urinary protein loss?

A) Glomerular crescent formation
B) Loss of glomerular basement membrane anions
C) Nodular glomerulosclerosis
D) Thinning of the glomerular basement membrane
E) Tubular necrosis and epithelial shedding

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