Help - Renal USMLE Rx question - What do you think?

[Phloston]

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In USMLE Rx, here is a vignette I got:

A 26-year-old man complains of swelling of his lower legs for the past 2 weeks. His blood pressure is 140/90 mm Hg. Physical examination confirms the patient's dependent edema. Urinalysis reveals dysmorphic RBCs, RBC casts, and proteinuria. The image shown is consistent with this patient's condition.

Which of the following is a characteristic of this patient's disease?

(then they give you the SAME EXACT colored image that is the "membranous glomerulonephritis" one on p.517 of FA)

A) Hemoptysis

B) Onset is often during an upper respiratory tract infection

C) Progressive hearing loss in the second decade of life

D) Slow progression to renal failure

E) Spontaneous resolution


USMLE Rx says the answer is D, and that this is membranoproliferative glomerulonephritis.

--> Could someone please explain why I should specifically think MPGN here (especially since the picture is MGN, not MPGN)?

 

[ijn]

Hypertension and RBC casts are most associated with nephritic syndrome. MGN would only have the symptoms of nephrotic syndrome. MPGN could have the symptoms of both nephrotic and nephritic syndromes.

As for the picture, I guess that is an error? Their question seems excessively cryptic. They should be clear on the level of proteinuria (>3.5 g/day) and/or say something about foamy urine or hypercoagulability/increased infections/hyperlipidemia.