No casts or cellular elements are seen.

The ultrasound shows kidneys of normal size with normal echogenicity and without hydronephrosis. A fetal ultrasound is normal for gestational age.

Kidney biopsy would be premature in this case, and is high risk in pregnancy. An active urine sediment, nephrotic range proteinuria, or rapidly deteriorating kidney function would make a stronger case to perform a biopsy for this patient. Try a less invasive test!

Correct! This is the gold standard test for the most likely diagnosis in this pregnant patient with worsening hypertension, greater than 20 weeks gestation. A spot urine protein:creatinine ratio would be an acceptable alternative. Her 24 hour urine collection reveals 530 mg  proteinuria.

Complement levels may help us in the investigation of a nephritic syndrome. Despite her elevated blood pressure and abnormal kidney function, the absence of red blood cells goes against a nephritic syndrome. Try again!

We might send this test if we suspected a connective tissue disease (CTD), like systemic lupus erythematosus (SLE). This patient’s initial presentation oes not suggest SLE or other CTD. Try again!

This patient’s hypertension has a more likely etiology given her history. PRA and aldosterone levels can be helpful in the investigation of secondary hypertension without a clear etiology. Try something else!

This patient is not thrombocytopenic. Mild anemia can be a common finding in pregnancy. Pick again!