23 year old male with 3 weeks of malaise and fatigue. Temperature is 101.2. Cardiac auscultation reveals an apical holosystolic murmur radiating to the axilla, which aunt present in the past. Labs show creatinine of 2.3. Mild proteinuria and microscopic hematuria with red cell casts are present on UA. Most likely pathogenesis of patient's renal findings?

The renal findings in a 23-year old male patient presenting with fatigue, a fever, a detected cardiac murmur, and abnormal urinalysis results can suggest a poststreptococcal glomerulonephritis condition, likely caused by an infection.

Explanation:

The symptoms and factors listed in the question, such as malaise, fatigue, changes in cardiac sounds, the presence of a fever, elevated creatinine, mild proteinuria, and the presence of microscopic hematuria with red cell casts in urinalysis, can indicate a renal condition likely caused by an infectious or inflammatory process. In this case, the most probable cause of the patient's renal findings could be poststreptococcal glomerulonephritis (PSGN). It is an immune-mediated disorder which typically occurs 1-2 weeks after the resolution of a streptococcal infection, and can appear as fatigue, malaise, and fever. Cardiac auscultation findings of a holosystolic murmur may suggest the development of endocarditis due to the infection. The presence of red blood cell casts, proteinuria, and elevated creatinine levels all indicate involvement of the renal system.

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