<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 32-year-old man comes to the physician because of a 2-week history of a cough and shortness of breath. He also noted several episodes of blood-tinged sputum over the last 4 days. He has a 3-month history of progressive fatigue. His temperature is 37.5C 98.6F, pulse is 86min, respirations are 17min, and blood pressure is 15093 mm Hg. Examination shows pale conjunctivae. Crackles are heard on auscultation of the chest. Laboratory studies show:Hemoglobin 10.2 gdLLeukocyte count 9200mm3Platelet count 305,000mm3SerumNa 136 mEqLCl- 101 mEqLK 4.5 mEqLHCO3- 25 mEqLUrea nitrogen 28 mgdLCreatinine 2.3 mgdLAnti-GBM antibodies positiveAntinuclear antibodies negativeUrineBlood 2Protein 2RBC 1113hbfRBC casts rareHe is started on prednisone and cyclophosphamide. Which of the following is the most appropriate next step in management?? A: Administer inhalative fluticasone, B: Perform hemodialysis, C: Administer immune globulins, D: Perform plasmapheresis, E: Administer enalapril,  <response>: This is a clinical vignette describing a 32-year-old man with a 2-week history of cough, shortness of breath, and blood-tinged sputum. He has fatigue, pale conjunctivae, crackles on lung exam, anemia, leukocytosis, thrombocytosis, renal insufficiency, and positive anti-GBM antibodies. This presentation is most consistent with anti-GBM disease, a type of autoimmune glomerulonephritis. The patient has been started on immunosuppression with prednisone and cyclophosphamide. Of the choices given, plasmapheresis would be the most appropriate next step in management to remove anti-GBM antibodies. Inhalative fluticasone, immune globulins, enalapril would not be helpful. Hemodialysis may eventually be needed for renal failure but plasmapheresis should be tried first to potentially improve kidney function by removing antibodies.D: Perform plasmapheresis 