The right kidney measures 14cm in length (seen here), and the left kidney measures 15cm in length. Both are echogenic.

This test would be more useful in the initial work-up of a patient with nephritic syndrome – here, the clinical picture is more consistent with nephrotic syndrome. Try again!

Absolutely! The patient is hepatitis B immune (surface antibdy positive, core antibody negative). Both HIV and hepatitis C antibodies are negative. Hepatitis B is associated with membranous nephropathy (MN) and HIV can lead to collapsing FSGS (both nephrotic syndromes). Though Hepatitis C is more often associated with membranoproliferative glomerulonephritis, hepatitis C-associated MN is also possible.

While these may be useful to assess his level of inflammation, ESR and CRP are non-specific and will not be highest yield in sorting out his kidney problem. Try again!

Not the best test for this patient with nephrotic range proteinuria without hematuria. Try again!

Great choice! SPEP shows a polyclonal gammopathy with IgG 1700, IgA 600, IgM 15. The ratio of kappa to lambda FLC is within normal limits.

Good choice! This patient’s ANA is 1:80 (normal <1:80). For good measure you also send an anti-dsDNA, which is negative.

You should absolutely check for diabetes in a patient with proteinuria and enlarged kidneys. His A1c is 5.9%, consistent with pre-diabetes.

This is a reasonable test to send for a with nephrotic range proteinuria. You’ve sent the sample to an outside laboratory, and it will take a few days to come bac.