A 9-Year-Old Boy Is Brought to the Clinic for Evaluation

A 9-year-old boy is brought to the clinic for evaluation of dark brown urine for a day.  He has had no fever, dysuria, hesitancy, or urinary frequency.  For the past 3 days, the patient has had rhinorrhea, nasal congestion, and a sore throat, but these symptoms are improving.  He has bilateral, sensorineural hearing loss that has worsened over the past 4 years.  A maternal uncle died from complications of a renal transplant 5 years ago.  Temperature is 37.1 C (98.8 F) , blood pressure is 132/94 mm Hg, pulse is 90/min, and respirations are 14/min.  The abdomen is soft and nontender and has no palpable masses.  There is no suprapubic or costovertebral angle tenderness.  Urinalysis reveals hematuria.  Serum creatinine is 1.4 mg/dL, and serum complement levels are normal.  A renal biopsy is performed.  Which of the following is the most likely histologic finding?

A) Effacement of podocyte foot processes
B) Linear deposition of IgG along the glomerular basement membrane
C) Longitudinal splitting of the glomerular basement membrane
D) Mesangial and glomerular capillary deposition of C3 and IgG
E) Mesangial deposition of IgA

Correct Answer:

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