Isolated Haematuria Biopsy Decision — ESENeph MCQ

Correct answer: C — Monitor urine ACR, blood pressure and kidney function longitudinally

The best answer is “Monitor urine ACR, blood pressure and kidney function longitudinally”. In an otherwise low-risk presentation, surveillance detects emerging proteinuria, hypertension or eGFR decline that would change the biopsy decision; the diagnosis of IgA nephropathy itself remains histological. “Arrange kidney biopsy and review the histological findings longitudinally” is less appropriate because IgA nephropathy cannot be diagnosed from haematuria alone and biopsy may not alter low-risk management “Begin systemic glucocorticoids and monitor protein excretion longitudinally” is less appropriate because there is no biopsy diagnosis or proteinuric progressive disease to justify immunosuppression “Begin cyclophosphamide and monitor kidney function longitudinally” is less appropriate because there is no rapidly progressive glomerulonephritis “Arrange urinary-tract imaging and reassess the surveillance strategy longitudinally” is less appropriate because repeated ionising imaging is not the nephrology monitoring pathway described

Reference: KDIGO 2025 IgA nephropathy and IgA vasculitis guideline: https://kdigo.org/wp-content/uploads/2025/09/KDIGO-2025-IgAN-IgAV-Guideline.pdf