A 17-Year-Old Boy Is Evaluated in the Office Due to Progressive

A 17-year-old boy is evaluated in the office due to progressive facial puffiness, fatigue, and decreased appetite for the past month.  Temperature is 36.7 C (98.1 F) , blood pressure is 110/70 mm Hg, pulse is 80/min, and respirations are 18/min.  Physical examination shows periorbital and pretibial edema.  Serum laboratory results are as follows: Urinalysis shows 4+ proteinuria, no red blood cells, and no casts.  A renal biopsy is performed.  Immunofluorescence microscopy shows a diffuse, granular pattern of IgG and C3 along the capillary loops, and electron microscopy shows electron-dense immune deposits along the glomerular basement membrane, findings consistent with membranous nephropathy.  Which of the following additional studies should be performed in this patient?

A) Antistreptolysin O titers
B) Audiology evaluation
C) Echocardiography
D) Hepatitis B serologies
E) No additional workup

Correct Answer:

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