Glomerular Diseases USMLE Step 1 Practice Question
A 62-year-old man with a 12-year history of type 2 diabetes mellitus presents with progressive dyspnea, lower extremity edema, and weight gain over the past 3 months. Physical examination reveals BP 158/92 mmHg, bilateral ankle edema, and fine crackles at bilateral lung bases. Fundoscopic examination demonstrates microaneurysms, dot-blot hemorrhages, and hard exudates. Laboratory studies show: serum creatinine 2.1 mg/dL, BUN 48 mg/dL, serum albumin 2.8 g/dL, 24-hour urine protein 3.8 g. Urinalysis shows 2+ protein and no hematuria. Renal biopsy with light microscopy reveals nodular glomerulosclerosis with acellular, homogeneous eosinophilic nodules in the glomerular mesangium. Which of the following is the most characteristic pathologic finding in this patient's glomerular disease?
Answer choices
- AElectron-dense deposits in the subendothelial space
- BSplitting of the glomerular basement membrane (GBM) with 'basket-weave' appearance on electron microscopy
- CWire-loop lesions and fibrinoid necrosis of capillary walls
- DCellular and fibrocellular crescents in Bowman's space
- EKimmelstiel-Wilson nodules composed of glycoprotein and hyaline materialCorrect answer
- FUniform thickening of the GBM with thinning of foot processes on electron microscopy
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