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.

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.

1:320 (reference: less than 1:80). In a women of this age and an active urine sediment, autoimmune disease such as systemic lupus erythematosus should be on our differential.  This is a high yield test.

Negative. In a women of this age and an active urine sediment, autoimmune disease such as systemic lupus erythematosus should be on our differential.  This is a high yield 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.