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CHALLENGING CLINICAL CASE NO. 02/2001

A 40-year-old woman who has never had significant respiratory disease is hospitalized for evaluation of hemoptysis. Urinalysis reveals 2 + proteinuria and microscopic hematuria. BUN concentration is 7.1 mmol/L (20 mg//dL), and serum creatinine concentration is 177 Ámol/L (2.0 mg/dL). Serologic findings include normal complement levels, increased immunoglobulin A levels, and a negative assay for fluorescent antinuclear antibodies. Renal biopsy reveals granulomatous necrotizing vasculitis with scattered imminolobulin and complement desposits. The most likely diagnosis in this case is

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