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Nephrotic-range proteinuria — ESENeph MCQ

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HardChronic Kidney DiseaseNephrotic-range proteinuriaESENeph

A 45-year-old man has CKD G3b and nephrotic-range proteinuria. He has no diabetes; blood pressure is 154/92 mmHg, ACR is 285 mg/mmol and serum albumin is 29 g/L. Urine microscopy shows oval fat bodies but no red cell casts; ultrasound shows normal-sized kidneys. What is the most appropriate investigation?

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

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Correct answer: D — Native kidney biopsy

Nephrotic-range proteinuria in a non-diabetic adult with normal-sized kidneys generally warrants renal biopsy to define the glomerular diagnosis and guide treatment. Cystoscopy assesses lower urinary tract causes of haematuria, not heavy albuminuria. ACE inhibition is appropriate supportive care but should not replace diagnostic evaluation. The pearl is that biopsy decisions depend on the likelihood that histology will change management and the risk of the procedure.

Reference: KDIGO 2021 Glomerular Diseases Guideline; Renal Medicine 2022 Curriculum