Seronegative MN Investigation — ESENeph MCQ
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Correct answer: A — Evaluate secondary causes and interpret additional tissue-antigen findings
The best answer is “Evaluate secondary causes and interpret additional tissue-antigen findings”. KDIGO requires assessment for infections, autoimmune disease, medicines and age-appropriate malignancy risk; antigen staining can refine classification but does not replace clinical evaluation. “Classify primary disease after completing secondary-cause evaluation” is less appropriate because seronegativity does not establish primary membranous nephropathy “Begin rituximab after infection and malignancy evaluation is complete” is less appropriate because treatment risk and disease classification depend on that assessment “Repeat PLA2R and extend the secondary investigation when indicated” is less appropriate because this delays clinically relevant secondary-cause evaluation “Use podocyte genetic testing when phenotype and age support it” is less appropriate because adult membranous nephropathy has a broader secondary differential
Reference: KDIGO 2021 glomerular diseases guideline with 2024 chapter updates: https://kdigo.org/wp-content/uploads/2024/05/KDIGO-2021-Glomerular-Diseases-Guideline_English_2024-Chapter-Updates.pdf