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Nephrotic Syndrome Workup — RACP Adult Medicine MCQ

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EasyNephrologyNephrotic Syndrome WorkupRACP Adult Medicine

A 30-year-old man presents with nephrotic-range proteinuria (ACR 350 mg/mmol), peripheral oedema, and hypoalbuminaemia (albumin 18 g/L). eGFR is 90 mL/min/1.73m². Urinalysis shows no haematuria. He has no diabetes or systemic disease. What is the most appropriate investigation?

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Correct answer: C — Refer for kidney biopsy

Nephrotic syndrome (proteinuria >3.5 g/day equivalent, hypoalbuminaemia, oedema) in a young adult without diabetes requires kidney biopsy to determine the underlying glomerular disease (minimal change, membranous, FSGS). The biopsy guides treatment (corticosteroids for MCD, rituximab/CNI for membranous, etc.). RAAS inhibition should be commenced concurrently.

Reference: KDIGO – 2021 – Glomerular Disease Guidelines; KHA-CARI 2024