A 17-Year-Old Boy Is Evaluated for Abnormal Urinalysis Findings

A 17-year-old boy is evaluated for abnormal urinalysis findings.  He came to the clinic 2 weeks ago with low back pain, and a urinalysis at that time showed 2+ protein.  He currently feels fine and has no urinary complaints.  The patient has not exercised vigorously or taken any medications.  He has no other medical problems and received all appropriate childhood vaccinations.  He does not use tobacco or illicit drugs.  The patient is not sexually active.  His father had early coronary disease and a stroke.  His blood pressure is 112/70 mm Hg and pulse is 77/min.  BMI is 24 kg/m².  Physical examination shows no abnormalities.  Laboratory results from this visit are as follows: Urine sediment microscopy is unremarkable for casts.  A 24-hour urine collection shows 600 mg of protein (normal <150 mg) .
Ultrasound of the kidneys shows no abnormalities.  Split urine collection shows 40 mg of protein overnight (8 hours) and 500 mg of protein during the day (16 hours) .  Which of the following is the best next step in management of this patient?

A) Lisinopril
B) No further intervention
C) Oral prednisone
D) Ultrasound-guided kidney biopsy
E) Urine protein testing in first-degree relatives

Correct Answer:

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