The old adage goes, “When you hear hoofbeats, think horses, not zebra” — except in this case when you should definitely think zebra.

In fact, a whole herd of them.

A 21-year-old man presented to a nephrology clinic in China with a 10-year history of intermittent burning pain in his arms and legs, and one month of foamy urine.

Urinalysis revealed proteinuria, serum creatinine was 81μmol/L (normal: 62-106 μmol/L) and urinary protein excretion was 1335mg/24hrs (normal: 0-140).