skip to main content

Non-diabetic kidney disease in diabetes — ESENeph MCQ

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

HardHypertension and Renovascular DiseaseNon-diabetic kidney disease in diabetesESENeph

A 58-year-old man with type 2 diabetes develops abrupt nephrotic syndrome. Diabetes duration is 4 years, HbA1c is 54 mmol/mol and retinal screening is normal. Creatinine is 132 micromol/L, ACR is 520 mg/mmol and urine microscopy shows red cell casts. What is the most appropriate investigation?

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

Reveal the answer and explanation

Correct answer: D — Native kidney biopsy

Short diabetes duration, absence of retinopathy, abrupt nephrotic-range albuminuria and red cell casts are atypical for diabetic kidney disease and warrant biopsy. Assuming diabetic nephropathy risks missing treatable glomerulonephritis. Cystoscopy is not the first test for active glomerular sediment and nephrotic proteinuria. The pearl is that diabetes does not exclude another kidney disease.

Reference: KDIGO 2024 CKD Guideline; Renal Medicine 2022 Curriculum