Medicine

A 19-year-old man presents to the emergency department complaining of coughing up blood and decreased urine output. On physical examination, there is normal air entry in the lungs, and the heart sounds are normal. There is no skin rash or palpable lymph nodes and his abdomen is normal. CXR reveals patchy infiltrates in both lower lobes and his creatinine is elevated. Urinalysis is positive for red cells and protein. A renal biopsy is performed and it reveals autoantibodies to basement membranes. Which of the following is the most likely diagnosis?