A 7-Year-Old Boy Is Brought to the Office Due to Swelling

A 7-year-old boy is brought to the office due to swelling of the hands and feet.  Two weeks ago, the patient was treated for anaphylaxis following a bee sting.  During the past 10 days, he has had progressive hand and foot swelling, and his pants feel tighter than usual.  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

Correct Answer:

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