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MPGN Pattern Investigation — ESENeph MCQ

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HardGlomerulonephritisMPGN Pattern InvestigationESENeph

Kidney biopsy shows an immune-complex membranoproliferative pattern with low C3 and C4. What is the essential next diagnostic step?

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Correct answer: ASearch for infection, autoimmune disease and monoclonal immunoglobulin

The best answer is “Search for infection, autoimmune disease and monoclonal immunoglobulin”. Immune-complex MPGN can accompany chronic infection, lupus or cryoglobulinaemia and MGRS; targeted treatment requires identifying the driver. “Classify primary MPGN after excluding an identifiable systemic driver” is less appropriate because MPGN is a pattern whose cause determines treatment “Request complement studies when alternative-pathway disease remains suspected” is less appropriate because low C3 and C4 with immune deposits points first to classical-pathway drivers “Measure anti-PLA2R when the biopsy pattern suggests membranous nephropathy” is less appropriate because that addresses membranous nephropathy rather than the broad MPGN differential “Test for hepatitis C when exposure or infection findings support it” is less appropriate because a complete cause assessment is required rather than one presumption

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