A 32-year-old white woman comes to the physician because of fatigue, lethargy, and swelling of the lower legs for 2 months. She reports recurrent episodes of pain in both wrists, her right knee, and her right ankle in the past year. She has recurrent oral ulcers. She has smoked one pack of cigarettes daily for 13 years and drinks one alcoholic beverage daily. Her temperature is 37.0°C (98.6°F), pulse is 92/min, and blood pressure is 115/75 mm Hg. Examination shows 2+ pretibial edema bilaterally and periorbital edema. There are erythematous patches with scaling on both cheeks. Twenty-four-hour urine protein excretion is 4.5 g. Serum antinuclear antibodies are present. Kidney biopsy shows glomerular capillary wall thickening with no increase in cellularity. When the sample is stained with methenamine silver, irregular spikes protruding from the glomerular basement membrane are seen. This patient most likely has which of the following conditions?

Question

A 32-year-old white woman comes to the physician because of fatigue, lethargy, and swelling of the lower legs for 2 months. She reports recurrent episodes of pain in both wrists, her right knee, and her right ankle in the past year. She has recurrent oral ulcers. She has smoked one pack of cigarettes daily for 13 years and drinks one alcoholic beverage daily. Her temperature is 37.0°C (98.6°F), pulse is 92/min, and blood pressure is 115/75 mm Hg. Examination shows 2+ pretibial edema bilaterally and periorbital edema. There are erythematous patches with scaling on both cheeks. Twenty-four-hour urine protein excretion is 4.5 g.  Serum antinuclear antibodies are present.  Kidney biopsy shows glomerular capillary wall thickening with no increase in cellularity.  When the sample is stained with methenamine silver, irregular spikes protruding from the glomerular basement membrane are seen.  This patient most likely has which of the following conditions?

Quizplus · Accepted Answer

Eductional Objective: Membranous glomerulopathy is a common cause of nephrotic syndrome in adults and can occur in association with solid malignancy, viral hepatitis, and systemic lupus erythematosus.  Immune-complex deposition in the subepithelial portion of the glomerular capillary wall causes diffuse thickening of the glomerular basement membrane (without increased cellularity); these deposits have a "spike and dome" appearance when stained with silver stains.

A 32-Year-Old White Woman Comes to the Physician Because of Fatigue