Which statement best describes the hallmark clinical features of glomerulonephritis?

• A. Hypertension, hematuria with RBC casts, dependent edema, and azotemia
• B. Proteinuria only
• C. Hematuria with WBC casts
• D. Hypotension with edema

Answer: (C)

Glomerulonephritis involves inflammation of the glomeruli that leads to leakage of blood elements into the urine and impaired kidney function. The hallmark sign is hematuria with red blood cell casts, which reflect bleeding from the glomeruli and tubular injury. This red cell–rich sediment is more specific than other casts and points to a glomerular source of bleeding. WBC casts, by contrast, are more typical of tubulointerstitial processes or lower urinary tract inflammation rather than primary glomerular disease. Hypertension and edema arise because the damaged glomeruli reduce filtration and promote sodium and water retention, while azotemia indicates rising waste products in the blood from decreased GFR. Proteinuria can occur in glomerulonephritis but is not the sole or most specific feature. So the description that encompasses hypertension, hematuria with RBC casts, edema, and azotemia best captures the hallmark clinical features of glomerulonephritis.