Case 50: Additional Diagnostic Testing

Case 50 Index

Which ONE of the following is the next best step here?
Urine microscopy
Great choice – when in doubt, spin that urine. Below is an image of the urine sediment
(Left: light microscopy; Right: polarized sample)
Complement levels (C3, C4)
Our data so far does not suggest a nephritic syndrome, let’s hold off on checking the complement levels for now. Pick again!
Human immunodeficiency virus (HIV) antibody
Good choice, the test is negative.
While age-appropriate cancer screenings are important, the likelihood of a colonic mass explaining our current presentation is a bit lower than other explanations. Pick again!
Kidney biopsy
In this patient with nephrotic range proteinuria, kidney biopsy may provide additional information. But there’s a cheaper, less invasive test that might help us first…
Urine eosinophils
Hm, not the best test here. This test might be ordered in patients to look for acute interstitial nephritis, but it’s not a great test there either. Try again!

Your team decides a biopsy might provide additional information here…

Click here to take a look under the microscope!

Case 50 Index
Case 50 Introduction
Case 50 Physical Exam
Case 50 Diagnostic Testing