Patients with a pure nephrotic syndrome without hematuria are less likely to have a kidney disease associated with hypocomplementemia. Let’s try a different test.

Excellent! Age appropriate cancer screenings are an essential part of the evaluation of this patient with nephrotic syndrome. A colonoscopy completed 2 years ago did not reveal any lesions .

Negative. HIV nephropathy often presents with nephrotic syndrome – this is a high yield test for this case.

5.8% (ref: 4 – 5.6%)

This is a reasonable diagnostic test for this patient, though the lab tells you that the result from this test won’t be ready for a few days.

Hepatitis C infection is usually associated with membranoproliferative glomerulonephritis with cryoglobunlinemia, and a nephritic syndrome. As our patient here has a nephrotic syndrome, try a higher yield test.

Negative. Good thought, hepatitis B is typically associated with membranous nephropathy and nephrotic syndrome.

This patient’s age makes this a lower yield test, though connective tissue disorders can lead to a similar presentation. Pick again!

In an older man, systemic lupus erythematosus is lower on our differential diagnosis. Try another test!

No evidence of monoclonal protein (no M-spike), normal ratio of kappa and lambda light chains. Though more likely to be diagnosed in an older patient, monoclonal gammopathies are associated with glomerular disease and nephrotic syndrome.

LDL 307 mg/dL, HDL 59 mg/dL, total cholesterol 398 mg/dL, triglycerides 160 mg/dL. In patients with nephrotic syndrome, hypoalbuminemia (low albumin levels) and low oncotic pressure lead to reactive hepatic synthesis – and subsequently increased synthesis of lipoproteins.