IgA Vasculitis Nephritis — ESENeph MCQ
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Correct answer: D — Consider kidney biopsy for histological diagnosis
The best answer is “Consider kidney biopsy for histological diagnosis”. KDIGO states that IgA nephropathy can be diagnosed only by kidney biopsy. To support early diagnosis, biopsy should be considered in adults with possible IgA nephropathy when proteinuria is at least 0.5 g/day and biopsy is not contraindicated. “Diagnose IgA nephropathy from serum IgA concentration alone” is less appropriate because there is no validated blood or urine biomarker that replaces kidney biopsy “Wait for nephrotic-range proteinuria before considering biopsy” is less appropriate because the current diagnostic threshold for biopsy consideration is 0.5 g/day “Use the Oxford MEST-C score before obtaining renal tissue” is less appropriate because MEST-C is a histological score that can be assigned after biopsy “Exclude IgA nephropathy because kidney function is preserved” is less appropriate because early IgA nephropathy commonly presents with haematuria and proteinuria before GFR declines
Reference: KDIGO 2025 IgAN and IgAV guideline: https://kdigo.org/wp-content/uploads/2024/08/KDIGO-2025-IgAN-IgAV-Guideline.pdf