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Nephrotic syndrome — MCCQE Part 1 MCQ

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ModerateEdemaNephrotic syndromeMCCQE Part 1

42-year-old man presents with periorbital swelling and leg oedema. Urinalysis shows 4+ protein, serum albumin is low and creatinine is mildly elevated. Which of the following is the most appropriate next step?

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Correct answer: B — Quantify proteinuria, assess renal function and refer urgently to nephrology

Quantify proteinuria, assess renal function and refer urgently to nephrology is best because heavy proteinuria with hypoalbuminaemia and oedema indicates nephrotic syndrome. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Nephrotic syndrome carries thrombotic, infectious and renal risks.

Reference: Canadian Society of Nephrology guidance