Glomerular Diseases USMLE Step 1 Practice Question
A 28-year-old man presents with a 3-week history of gross hematuria following an upper respiratory infection. He reports mild flank discomfort but denies arthralgia, abdominal pain, or rash. Vital signs are BP 138/88 mmHg, HR 88/min, temperature 37.0°C. Urinalysis shows 3+ proteinuria, dysmorphic RBCs, and RBC casts. Serum creatinine is 1.3 mg/dL (baseline unknown). Complement levels (C3, C4) are normal. Kidney biopsy demonstrates IgA-dominant immune deposits in the glomerular mesangium on immunofluorescence microscopy, with mesangial proliferation on light microscopy. Which of the following is the most significant long-term prognostic factor in this patient?
Answer choices
- AThe degree of proteinuria and presence of hypertension at presentationCorrect answer
- BSerum IgA level elevation
- CThe timing of hematuria onset relative to upper respiratory infection
- DPresence of dysmorphic RBCs on urinalysis
- ENormal complement levels
- FPatient age at time of diagnosis
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