Great choice! Here’s an image of the right kidney. It measures 14 cm across. (Image courtesy Dr. Julius Rozmiarek, from the Radiopaedia.org Case 62615)

It is important to assess this patient’s HIV viral load, which can increase his risk for certain types of kidney disease. His viral load is >1,000,000 copies/mL, and CD4 count is 120 cells/uL.

This would be a good choice for a patient with nephritic syndrome. Try again!

Great choice! It is important to assess for HCV and/or HBV co-infection, as these viruses can lead to a variety of kidney pathology. This patient tests negative for HBV and HCV.

Nice! This test can identify syphilis infection, which is an important cause of secondary membranous nephropathy and nephrotic syndrome.

Absolutely! This is a useful test in a patient with nephrotic range proteinuria. An elevated antibody titer would be consistent with membranous nephropathy and, some would argue, could spare the patient a kidney biopsy. This will take approximately 1 week to result.

Hm…this test has a low sensitivity, and its positive predictive value for acute interstitial nephritis (AIN) is only about 40%. Pick again!

This is a reasonable test for a patient with nephrotic range proteinuria to assess for a monoclonal gammopathy, though his younger age makes this less likely. His SPEP shows hypergammaglobulinemia without an M-spike, and serum free light chains are within normal. Monoclonal gammopathies can lead to variety of glomerular diseases that cause nephrotic range proteinuria including amyloidosis and light chain deposition disease (LCDD).