A 67-year-old woman with long standing rheumatoid arthritis has been treated with gold for a number of years. On a routine examination, edema, 4+ protein in the urine with lipiduria, and a serum albumin of 2.5 gm/dL are noted. A renal biopsy is performed and on light microscopy marked diffuse thickening of the glomerular capillary walls are noted. Which of the following mechanisms is most likely responsible for causing the glomerular capillary walls to become leaky, leading to this woman's nephrotic syndrome?
A. Altered renal tubular epithelial with cyst formation
B. Chronic activation of C5b-C9 pathway on glomerular endothelial and mesangial cells
C. Hypoperfusion of the glomerulus
D. Ischemic damage to the tubular epithelium leading to necrosis
E. Persistent overexpression of ENaC in cortical collecting tubule
A. Altered renal tubular epithelial with cyst formation
B. Chronic activation of C5b-C9 pathway on glomerular endothelial and mesangial cells
C. Hypoperfusion of the glomerulus
D. Ischemic damage to the tubular epithelium leading to necrosis
E. Persistent overexpression of ENaC in cortical collecting tubule