A 3-Year-Old Boy Is Brought to the Office Due to a Weeklong

question 376

Multiple Choice

A 3-year-old boy is brought to the office due to a weeklong history of edema that is gradually worsening.  The patient has not been ill recently, and his medical history is unremarkable.  He takes no daily medications, and vaccinations are up to date.  Temperature is 36.7 C (98.1 F) , blood pressure is 104/76 mm Hg, pulse is 85/min, and respirations are 18/min.  On examination, there is periorbital edema and 1+ pretibial pitting edema.  The remainder of the physical examination is normal.  Laboratory results are as follows: Urinalysis shows 4+ proteinuria and no red blood cells.  Which of the following is the best next step in management of this patient?

• A)Administer intravenous albumin
• B)Initiate ACE inhibitor therapy
• C)Initiate corticosteroid therapy
• D)Initiate statin therapy
• E)Obtain a kidney biopsy
• F)Order a kidney ultrasound

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