Final answer:
Acute glomerulonephritis can cause the shedding of renal tubular epithelial cells into the urine due to inflammation, but nephrotic syndrome is characterized by significant glomerular damage, leading to a higher number of cells being shed.
Step-by-step explanation:
The question asks which condition leads to the largest number of renal tubular epithelial cells being shed into the urine. The possible conditions provided as options are malignant renal disease, acute glomerulonephritis, nephrotic syndrome, and cytomegalovirus (CMV) infection of the kidney.
Acute glomerulonephritis is often associated with the shedding of renal tubular epithelial cells into the urine because it encompasses a variety of kidney diseases that often lead to inflammation of the glomeruli. These diseases can include anti-glomerular basement membrane disease, Wegener’s granulomatosis, and acute lupus nephritis. Although renal failure and obstruction (such as kidney stones) can also result in cell shedding, these are not provided as options in the question.
Nephrotic syndrome, however, is characterized by damage to the glomeruli, which increases the permeability of the glomerulus and leads to the passage of a significant amount of protein into the urine. This damage may lead to a higher number of renal tubular epithelial cells being shed. The presence of these cells in the urine is suggestive of renal tubular damage, which is more acute and severe in nephrotic syndrome compared to the other conditions listed.