Glomerulonephritis — Nephrotic

A 32-year-old Indian woman presents with progressive facial puffiness and leg swelling for 3 weeks. She reports foamy urine and denies recent infections or drug use. On examination: BP 128/82 mmHg, bilateral pitting ankle edema, no rash. Labs: serum albumin 2.1 g/dL, total protein 4.8 g/dL, 24-hour urine protein 8.2 g, serum creatinine 0.9 mg/dL, urinalysis shows 3+ proteinuria with occasional RBCs, no casts. Complement C3 and C4 are normal. Kidney biopsy shows capillary wall thickening with subepithelial "spike and dome" deposits on electron microscopy. What is the most likely diagnosis?

A 32-year-old woman from Delhi presents with nephrotic syndrome (proteinuria 8 g/day, serum albumin 2.1 g/dL, edema). Serum creatinine is 0.9 mg/dL and urinalysis shows selective proteinuria with no RBC casts. Complement levels are normal. Renal ultrasound is normal. What is the most appropriate next step in management?

A 35-year-old woman presents with nephrotic syndrome (proteinuria 4.5 g/day, hypoalbuminemia, edema). Kidney biopsy shows diffuse thickening of the glomerular basement membrane with a characteristic 'spike and dome' appearance on electron microscopy. What is the most common cause of nephrotic syndrome in this histological pattern?

In a series of 100 adult Indian patients presenting with nephrotic syndrome, kidney biopsies were performed. Which of the following is the most common histological pattern of glomerulonephritis causing nephrotic syndrome in this population?

A 58-year-old man with diabetes mellitus type 2 presents with nephrotic syndrome and declining renal function (eGFR 35 mL/min/1.73m²). Kidney biopsy shows nodular glomerulosclerosis (Kimmelstiel-Wilson nodules), hyaline arteriolosclerosis, and mesangial expansion. Which of the following is NOT consistent with diabetic nephropathy?