Rapidly progressive glomerulonephritis Quiz: Ace Your Exams

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A 50-year-old man comes to the emergency department with inability to urinate for the past 2 days. He also has noticed blood in his urine for the past week. The patient has had no pain with urination or myalgias. Review of the medical charts reveals multiple clinic visits for recurrent rhinosinusitis. Temperature is 38.2°C (100.8°F), pulse is 80/min, respirations are 20/min, and blood pressure is 160/95 mmHg. Physical examination shows 2+ peripheral pitting edema. There is no flank tenderness or tenderness on palpation of the lower abdomen.  Laboratory results are as follows:  
A table lists lab values: complete blood count shows hemoglobin 12 g/dL, leukocyte count 12,000/mm³, platelet count 400,000/mm³, HbA1c 5.6%. Urinalysis: blood present, protein 1+.

Serum creatinine is 4.0 mg/dL. Kidney biopsy is performed, and a light microscopy image is shown below:
A microscopy image shows a glomerulus with a dashed line around its periphery. The glomerulus has many cells, with some areas appearing pink and others purple.

The area marked is mainly composed of which of the following?

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