A 45-year-old woman presents to the emergency department with a 1-week history of hemoptysis, progressive dyspnea, and cola-colored urine. She denies recent infections, drug use, or systemic symptoms. Physical examination reveals bilateral crackles on lung auscultation. Laboratory studies show serum creatinine 2.8 mg/dL (baseline 0.9 mg/dL), hemoglobin 9.2 g/dL, and urinalysis with 3+ proteinuria, dysmorphic RBCs, and RBC casts. Chest X-ray demonstrates bilateral alveolar infiltrates. Serum ANCA panel (c-ANCA, p-ANCA) and ANA are negative. Serum complement levels (C3, C4) are normal. Kidney biopsy shows segmental crescentic glomerulonephritis with linear IgG deposition along the glomerular basement membrane on immunofluorescence microscopy. Which of the following is the most likely diagnosis?

  1. A)ANCA-associated vasculitis (granulomatosis with polyangiitis)
  2. B)Immune complex membranoproliferative glomerulonephritis
  3. C)Infective endocarditis-associated glomerulonephritis
  4. D)Anti-glomerular basement membrane diseaseGABARITO
  5. E)Cryoglobulinemia-associated vasculitis

Explicação

Anti-GBM disease (Goodpasture syndrome) is characterized by the classic triad of pulmonary hemorrhage (hemoptysis), glomerulonephritis (hematuria/dysmorphic RBCs), and rapidly progressive renal failure. The pathognomonic finding is LINEAR IgG deposition along ... Ver explicação completa e trilha adaptativa →

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