Rapidly progressive glomerulonephritis Quiz: Ace Your Exams

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A 32-year-old man comes to the office because of a cough and bloody sputum for 3 weeks. The onset of symptoms was preceded by sore throat and mild nasal congestion. He has no fever, weight loss, night sweats, or complaints of recurrent infections, but he does describe several episodes of red-colored urine. He does not smoke or use illicit drugs. Temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 20/min, and blood pressure is 152/88 mmHg. Physical examination shows bilateral inspiratory crackles. There is 1+ peripheral pitting edema. Chest x-ray reveals bilateral infiltrates. Serum creatinine is 3.2 mg/dL. Urinalysis shows mild proteinuria, hematuria, and red blood cell casts. Renal biopsy specimen under immunofluorescence microscopy is shown:
A close-up image shows a kidney glomerulus and surrounding tubules under immunofluorescence. Bright green patterns highlight structures against a dark background, indicating antibody binding.

Which of the following is the most likely diagnosis?

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