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 Best of Five 3.70

 

   

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BOF: 3.70

An 18-year-old male presented with a 3-month history of lethargy followed by a 2-week history of headache, nausea and vomiting. No history of joint pains, rash, cough or haemoptysis.

On examination, he was pale, blood pressure 180/110 mmHg.

Investigations:

Serum potassium 7.6 mmol/L

Urea 48 mmol/L

Creatinine 1726 Ámol/L

Haemoglobin 6.7 g/dL

Urinalysis demonstrated red blood cells with granular casts

24-urine albumin 1600 mg/L

Renal ultrasound demonstrated bright kidneys of normal size with loss of cortico-medullary differentiation

Renal biopsy showed a severe crescentic necrotising glomerulonephritis with intense linear deposition of IgG in the glomerular capillary walls.  No immune deposits on electron microscopy and the glomerular basement membrane was of normal thickness. In this patient which one of the following tests is most likely to be positive?

a)      Anti glomerular basement membrane antibody

b)      Anti streptolysin O titre

c)      Anti neutrophil cytoplasmic antibody

d)      Anti nuclear antibody

e)     Rheumatoid factor

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