A 61-Year-Old Man Comes to the Physician Because of Progressively

A 61-year-old man comes to the physician because of progressively worsening swelling of his ankles. He says he has felt exhausted lately. Over the past 3 months, he has gained 5 kg (11 lb) . He has smoked one pack of cigarettes daily for 30 years. His pulse is 75/min and his blood pressure is 140/90 mm Hg. Examination shows 2+ pitting edema in the lower extremities. Neurologic examination shows diminished two-point discrimination over the fingers and toes. Laboratory studies show a serum creatinine concentration of 1.9 mg/dL. A urine sample is noted to be foamy. A kidney biopsy is performed; light microscopic findings following staining with hematoxylin and eosin are shown in the image below: Which of the following is the most likely explanation for this patient's biopsy findings?

A) Bee sting with severe allergic reaction
B) Diabetes mellitus
C) Hepatitis C infection
D) HIV infection
E) Lung carcinoma
F) Recent streptococcal pharyngitis
G) Systemic lupus erythematosus
H) Treatment with procainamide

Correct Answer:

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