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15th July 2024
A 32-year-old woman was referred to an outpatient clinic with a one-month history of general malaise
A 32-year-old woman was referred to an outpatient clinic with a one-month history of general malaise and a 3-day history of joint pains. She had received a course of amoxicillin 2 weeks previously from her general practitioner for a presumed urinary tract infection (blood and protein evident on urine dip).
On examination, she had synovitis of the metacarpophalangeal joints of her right hand and an erythematous rash on her legs. Her blood pressure was 170/91 mmHg. Urinalysis showed blood ++ and protein +++. Blood tests showed:
| Haemoglobin | 91 g/L (115-165) |
| White cell count | 4.0 × 10⁹/L (4.0–11.0) |
| Platelet count | 125 × 10⁹/L (4.0–11.0) |
| Serum urea | 13.6 mmol/L (2.5-7.0) |
| Serum creatinine | 242 µmol/L (60-110) |
What is the most likely cause of her renal impairment?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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