<s>[INST] context: While in real life, other diseases (or combinations of diseases) may occasionally cause concurrent pulmonary, sinus, and renal involvement, if you see this pattern on a test question, you should immediately think of Wegener's granulomatosis. This is a rare focal necrotizing vasculitis of still unclear etiology, which also features prominent granulomas, some of which are centered on the vascular lesions. The vasculitis and granulomatous can involve the entire respiratory tract, and an easily obtained nasal biopsy may sometimes yield the diagnosis. The renal involvement is usually in the form of a necrotizing glomerulonephritis. The disease typically affects middle aged men, and its formerly poor prognosis has been improved by coicosteroid and cyclophosphamide therapy. Note: Aspergillosis can cause prominent lung disease, but does not usually have renal involvement. Polyaeritis nodosa is a possibility, but usually spares the lungs. Renal cell carcinoma might cause lung nodules, but there is no evidence of tumor in the kidney. [/INST] question: A 45-year-old man presents to his physician with hematuria. Renal biopsy demonstrates a focal necrotizing glomerulitis with crescent formation. The patient has a history of intermittent hemoptysis and intermittent chest pain of moderate intensity. A previous chest x-ray had demonstrated multiple opacities, some of which were cavitated. The patient also has chronic cold-like nasal symptoms. Which of the following is the most likely diagnosis? | options: A: Aspergillosis B: Polyaeritis nodosa C: Renal carcinoma metastatic to the lung D: Wegener's granulomatosis | answer: D </s>