A 41-Year-Old Woman Is Being Evaluated for Peripheral Edema

A 41-year-old woman is being evaluated for peripheral edema.  The patient has gained 6.8 kg (15 lb) over the past 8 weeks.  Her urine is "frothy."  She has no other medical problems and takes no medications.  The patient does not use tobacco, alcohol, or illicit drugs.  Blood pressure is 140/90 mm Hg and pulse is 80/min.  Examination shows generalized edema.  Heart sounds are normal.  The abdomen is soft and nontender.  Serum creatinine is 1.1 mg/dL.  Urinalysis shows 4+ protein, 0-3 leukocytes/hpf, and oval fat bodies.  Serum contains IgG4 antibodies to the phospholipase A2 receptor (PLA2R) , a transmembrane protein abundant on podocytes.  Which of the following is the most likely diagnosis?

A) Focal segmental glomerulosclerosis
B) Membranous nephropathy
C) Minimal change disease
D) Mixed cryoglobulinemia
E) Multiple myeloma

Correct Answer:

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