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Answer 4
  1. Membranous nephropathy. Glomerular disease presents as 4 distinct clinical syndromes: nephritic syndrome, rapidly progressive glomerulonephritis, asymptomatic abnormalities on urinalysis, and nephrotic syndrome. The nephritic syndrome is characterized by the presence of hematuria, red blood cell casts on urinalysis, varying degrees of hypertension, and proteinuria (often < 3 g).4 Rapidly progressive glomerulonephritis is a variant of nephritic syndrome. Renal function deteriorates rapidly over days to weeks and is characterized by cellular or fibrous crescents on biopsy. Asymptomatic abnormalities on urinalysis include hematuria or proteinuria on dipstick. Nephrotic syndrome is characterized by severe proteinuria (usually > 3 g), hypoalbuminemia, edema, and hyperlipidemia. Based on this patient’s symptoms and results of urinalysis, he has membranous nephropathy, 1 of the primary renal diseases that presents as nephrotic syndrome. Other primary renal diseases that present as nephrotic syndrome include minimal change disease, focal segmental glomerulosclerosis, and occasionally membranoproliferative glomerulonephritis.

     Orth SR, Ritz E. The nephrotic syndrome. N Engl J Med 1998;338:1202–11.

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