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Nephrotic Syndrome Biopsy Indication — RACP Adult Medicine MCQ

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EasyNephrologyNephrotic Syndrome Biopsy IndicationRACP Adult Medicine

A 25-year-old man with nephrotic syndrome (proteinuria 8 g/day, albumin 18 g/L, oedema) and normal renal function presents with no haematuria. He has no diabetes or systemic disease. ANA, ANCA, anti-GBM, complement levels, and hepatitis serology are all normal. What is the most appropriate next investigation?

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Correct answer: A — Renal biopsy

Nephrotic syndrome in an adult without diabetes requires kidney biopsy for histological diagnosis — treatment differs substantially between causes (MCD: steroids; FSGS: steroids ± calcineurin inhibitors; membranous: rituximab/CNI if anti-PLA2R positive). Children with nephrotic syndrome are empirically treated with steroids (likely MCD); biopsy is reserved for atypical features or steroid resistance.

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