When would you consider a kidney biopsy in a patient with longstanding diabetes and hypertension (baseline creatinine 4-5, 4+ proteinuria) who was recently found to have dsDNA positivity?

Under what circumstances would you perform a kidney biopsy in a patient with longstanding diabetes and hypertension who was recently found to have dsDNA positivity?

• Abrupt increase in urine protein
• Increase in trajectory of serum creatinine
• New microscopic hematuria
• Symptoms suggestive of SLE
• I would do a kidney biopsy on all patients with proteinuria and a positive dsDNA
• Other