skip to main content

IgAN Classic Clinical Presentation — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

EasyGlomerulonephritisIgAN Classic Clinical PresentationESENeph

A 50-year-old man with CKD G3b has intermittent gross haematuria episodes that coincide with URTIs. Between episodes he has microscopic haematuria and proteinuria 0.8 g/day. His C3 and C4 are normal. No biopsy has been performed. What is the most likely clinical diagnosis even before biopsy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — IgA nephropathy – synpharyngitic gross haematuria (within 1-2 days of URTI), persistent microscopic haematuria between episodes, normal complement, and proteinuria is the classic clinical presentation

The clinical scenario is virtually pathognomonic of IgA nephropathy: (1) synpharyngitic haematuria (gross haematuria within 24-48 hours of mucosal infection, reflecting IgA immune complex-mediated glomerular injury); (2) persistent microscopic haematuria between episodes; (3) proteinuria; (4) normal complement. Post-streptococcal GN has a 1-3 week latent period and low C3. Thin basement membrane disease rarely causes gross haematuria. While biopsy is needed for definitive diagnosis and MEST-C scoring, the clinical picture strongly supports IgAN and treatment can be initiated (RASi, SGLT2i) while awaiting biopsy.

Reference: KDIGO 2025 – IgAN Guideline