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IgA Nephropathy — RACP Adult Medicine MCQ

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ModerateNephrologyIgA NephropathyRACP Adult Medicine

A 25-year-old man develops visible haematuria (cola-coloured urine) concurrently with an upper respiratory tract infection. Urine microscopy shows dysmorphic RBCs and RBC casts. Proteinuria (PCR 80 mg/mmol). Complement levels (C3, C4) are normal. Renal function is preserved. What is the most likely diagnosis?

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Correct answer: A — IgA nephropathy

Synpharyngitic visible haematuria (concurrent with, not weeks after, URTI), dysmorphic RBCs, RBC casts, proteinuria, and normal complement is IgA nephropathy — the most common glomerulonephritis worldwide. The synpharyngitic timing differentiates from post-streptococcal GN (2-4 weeks after infection, low C3). Kidney biopsy confirms IgA deposits. Treatment: KDIGO 2025 recommends SGLT2i for all with proteinuria, with corticosteroids (TESTING trial) for persistent proteinuria despite RAAS blockade.

Reference: KDIGO – 2025 – IgAN; KHA 2024