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Nephrotic Syndrome — RACP Paediatrics MCQ

Instant feedback + full explanation. One question, done properly.

HardNephrologyNephrotic SyndromeRACP Paediatrics

A 13-year-old presents with oedema, nephrotic-range proteinuria and albumin 18 g/L. She also has sustained hypertension, macroscopic haematuria, low C3 and impaired kidney function not corrected by volume restoration. What is the most appropriate next step?

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

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Correct answer: A — Refer urgently to paediatric nephrology for diagnostic work-up and biopsy planning

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

E is correct. Age above 12 years, sustained hypertension, macroscopic haematuria, low complement and persistent kidney impairment are multiple atypical features. RCH advises early paediatric-nephrology discussion; current nephrotic guidance supports biopsy at presentation when atypical features suggest an alternative glomerulopathy. A incorrectly applies the uncomplicated minimal-change pathway. B begins toxic disease-specific therapy without diagnosis. C may worsen effective circulating volume and delays evaluation of kidney injury. D mislabels strong nephritic or systemic-disease signals as benign. Serology, renal imaging and biopsy timing should be directed by nephrology while complications such as hypertension and fluid imbalance are treated safely.

Reference: Royal Children’s Hospital Melbourne: Nephrotic syndrome: https://www.rch.org.au/clinicalguide/guideline_index/nephrotic_syndrome/ KDIGO 2025: Nephrotic syndrome in children: https://kdigo.org/wp-content/uploads/2025/04/KDIGO-2025-Guideline-for-Nephrotic-Syndrome-in-Children.pdf