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DKD Biopsy Decision — ESENeph MCQ

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HardDiabetic Kidney DiseaseDKD Biopsy DecisionESENeph

A 47-year-old with type 2 diabetes for six years develops haematuria with dysmorphic erythrocytes, rapidly increasing proteinuria and a 35% fall in eGFR over four months. Retinal photography is normal. What is the most appropriate next diagnostic step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Arrange kidney biopsy for suspected superimposed non-diabetic glomerular disease

Explanation lettering: C = shown as A · E = shown as C · A = shown as E

C is correct. Diabetes does not make every case of CKD diabetic kidney disease. Active glomerular sediment, rapid loss of kidney function, abrupt or disproportionate proteinuria and a course atypical for the duration of diabetes raise concern for a superimposed, potentially treatable glomerulopathy. Absence of retinopathy strengthens that concern but is not an absolute exclusion test. Biopsy follows nephrology assessment, serology and review of bleeding risk; empirical immunosuppression before diagnostic work-up is unsafe. Renal-artery imaging does not explain dysmorphic haematuria and rapidly increasing glomerular protein loss.

Reference: UK Kidney Association commentary on KDIGO diabetes in CKD: https://pmc.ncbi.nlm.nih.gov/articles/PMC9740752/