IgAN Natural History 20-Year Prognosis — ESENeph MCQ

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EasyGlomerulonephritisIgAN Natural History 20-Year PrognosisESENeph

A 35-year-old man with IgA nephropathy asks about the natural history of his disease. His biopsy shows MEST-C M1 E0 S0 T0 C0, eGFR 85, proteinuria 0.6 g/day. What percentage of IgAN patients progress to ESKD within 20 years?

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Correct answer: D — Approximately 20-40% progress to ESKD within 20 years of diagnosis; the remainder have stable or slowly progressive disease

IgA nephropathy has a variable natural history. Approximately 20-40% of patients progress to ESKD within 20 years. Risk factors for progression include persistent proteinuria >1 g/day (now revised to >0.5 g/day per KDIGO 2025), hypertension, reduced eGFR at diagnosis, and adverse MEST-C histology. However, many patients (60-80%) have stable or slowly progressive disease, particularly with optimised supportive care. The International IgAN Prediction Tool helps stratify individual risk. This patient has relatively favourable features (preserved GFR, moderate proteinuria, T0).

Reference: KDIGO 2025 – IgAN; Wyatt et al 2004 – IgAN Natural History