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26879 Medicine

A 24-year-old woman presents to the emergency department with symptoms of fever, chills and rigors. On physical examination, she looks unwell; the temperature is 39.4degC, blood pressure 100/60 mm Hg, pulse 110/min, and oxygen saturation 95%. There is a 3/6 pansystolic murmur at the right sternal border, which increases with inspiration. Her arms have multiple tattoos and needle marks from injection drug use. Blood cultures (2/2 sets) are positive for S aureus, and she is started on appropriate antibiotics. Her renal function is mildly impaired and her urinalysis is positive for protein, and microscopy reveals red cell casts. Which of the following mechanisms is the most likely explanation for her renal abnormalities?

Aseptic emboli
Bcardiac failure with prerenal azotemia
Ca high level of circulating immune complexes
Dfungal disease
Medicine
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