A 6-year-old boy presents with generalized edema, gross hematuria, and oliguria. Blood pressure is 130/85 mmHg. Investigations show heavy proteinuria (4+), hypoalbuminemia (2.0 g/dL), serum creatinine 1.8 mg/dL, and serum C3 is persistently low (35 mg/dL) for over 12 weeks. C4 is normal. What is the most likely diagnosis?

• A Post-streptococcal glomerulonephritis
• B Lupus nephritis
• C Minimal change disease
• D Membranoproliferative glomerulonephritis (MPGN) ✓

Explanation

MPGN presents with a mixed nephritic-nephrotic picture (hematuria plus heavy proteinuria and hypoalbuminemia) and characteristically shows persistently low D3 with normal D4 beyond 6 to 8 weeks. PSGN shows low D3 that normalizes within 6 to 8 weeks. Lupus nephritis shows both D3 and D4 low. Minimal change disease presents with pure nephrotic syndrome without hematuria or low complement.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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