<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 48-year-old African American male presents to his primary care provider complaining of facial swelling. He reports a three-day history of worsening swelling primarily around his eyes. The patients medical history is notable for sickle cell disease and poorly controlled hypertension. The patient currently takes enalapril, hydrochlorothiazide, and amlodipine but has a history of medication non-adherence. He has a 15 pack-year smoking history. His temperature is 99.1F 37.3C, blood pressure is 155100 mmHg, pulse is 90min, and respirations are 20min. Physical examination is notable for periorbital swelling and 1 bilateral lower extremity edema. Multiple serum and urine labs are ordered. A kidney biopsy in this patient would most likely yield which of the following sets of findings on light and electron microscopy?? A: Wire looping capillaries and subendothelial immune complex deposition, B: Hypercellular glomeruli with neutrophils and subepithelial immune complex deposition, C: Increased mesangial cellularity and mesangial immune complex deposition, D: Diffusely thickened capillaries and subepithelial immune complex deposition, E: Segmental sclerosis and negative immunofluorescence and foot process effacement,  <response>: This is a clinical vignette describing a 48-year-old African American male with facial swelling, poorly controlled hypertension, and a history of sickle cell disease presenting to his primary care physician. The question asks about expected kidney biopsy findings in this patient. Based on the description, the patient likely has nephrotic syndrome given the facial swelling, lower extremity edema, and hypertension. The differential diagnosis includes primary glomerular diseases like focal segmental glomerulosclerosis FSGS, membranous nephropathy, and minimal change disease. Sickle cell nephropathy could also cause similar findings. Choice A describes findings consistent with membranous nephropathy - subepithelial immune complex deposits and capillary wall thickening. Choice B describes a proliferative glomerulonephritis like post-infectious glomerulonephritis with neutrophils and subepithelial deposits. This is less likely.Choice C describes findings of mesangial proliferative glomerulonephritis like IgA nephropathy. This does not fit the clinical picture. Choice D describes membranous nephropathy. Choice E describes findings consistent with FSGS - segmental sclerosis, foot process effacement, and negative immunofluorescence. This fits the clinical scenario best in an African American male with nephrotic syndrome.E: Segmental sclerosis and negative immunofluorescence and foot process effacement 