Rapidly progressive glomerulonephritis Quiz: Ace Your Exams

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A 48-year-old man comes to the office with a 3-week history of dark brown urine. He also complains of a cough productive of pinkish sputum that started around the same time. Review of systems reveals loss of appetite, fatigue, and 7-kg (15-lb) weight loss over the last month. He has had no oral ulcers, joint pain, or rashes. Temperature is 38.2°C (100.8°F), pulse is 80/min, respirations are 20/min, and blood pressure is 135/85 mmHg. Physical examination shows bilateral wheezing. There is 2+ peripheral pitting edema. Serum creatinine is 1.3 mg/dL. Complete blood count and urinalysis results are shown below. Chest x-ray reveals bilateral nodular densities. Serum c-ANCA is positive. Renal biopsy is shown below. Which of the following additional findings are most likely to be found on further evaluation?




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