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IgA Nephropathy — ESENeph MCQ

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ModerateGlomerulonephritisIgA NephropathyESENeph

A 28-year-old man has a kidney biopsy showing mesangial IgA deposition with MEST-C M1 E0 S0 T0 C0. Proteinuria is 0.4 g/day, eGFR is 92 mL/min/1.73m2. He has microscopic haematuria. BP is 118/72 mmHg. According to KDIGO 2025, what is the recommended management?

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Correct answer: C — Optimise supportive care (RASi, BP control, SGLT2i); aim for proteinuria <0.5 g/day ideally <0.3 g/day

KDIGO 2025 IgAN guideline states that proteinuria ≥0.5 g/day is the threshold for active treatment (disease-modifying agents). This patient has proteinuria <0.5 g/day but the goal is <0.5 g/day ideally <0.3 g/day. Supportive/foundational care (RASi, SGLT2i, BP optimisation, lifestyle) should be initiated. Disease-modifying immunotherapy (e.g. Nefecon) is reserved for patients with proteinuria persisting at ≥0.5 g/day despite optimised supportive care. He should not be discharged as ongoing monitoring is needed.

Reference: KDIGO 2025 – IgA Nephropathy Guideline