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IgA Nephropathy — RACP Adult Medicine MCQ

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ModerateNephrologyIgA NephropathyRACP Adult Medicine

A 25-year-old man presents with macroscopic haematuria coinciding with an upper respiratory tract infection. He had a similar episode 2 years ago. Urinalysis shows dysmorphic red blood cells and proteinuria (ACR 35 mg/mmol). Serum C3 and C4 are normal. eGFR is 85 mL/min/1.73m². Kidney biopsy shows mesangial IgA deposition on immunofluorescence. What is the most likely diagnosis?

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Correct answer: D — IgA nephropathy

Synpharyngitic haematuria (concurrent with URTI, not delayed) with mesangial IgA deposition, normal complement, and recurrent episodes is diagnostic of IgA nephropathy (Berger disease). KDIGO 2025 IgAN guidelines recommend RAAS inhibition as first-line; SGLT2 inhibitors and targeted-release budesonide (Nefecon) are now recommended for high-risk patients.

Reference: KDIGO – 2025 – IgA Nephropathy Guidelines