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IgA Nephropathy — RACP Adult Medicine MCQ

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ModerateNephrologyIgA NephropathyRACP Adult Medicine

A 45-year-old man presents with macroscopic haematuria 2 days after an upper respiratory tract infection. Urine microscopy shows dysmorphic red blood cells and red cell casts. Serum creatinine is 120 µmol/L. Serum IgA is elevated. What is the most likely diagnosis?

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Correct answer: B — IgA nephropathy

Synpharyngitic macroscopic haematuria (occurring during or within 1–2 days of URTI, rather than the 1–3 week latency of post-streptococcal GN) with elevated serum IgA and nephritic sediment is classic for IgA nephropathy (Berger's disease). Renal biopsy (mesangial IgA deposition on immunofluorescence) confirms the diagnosis. The TESTING trial demonstrated benefit of reduced-dose corticosteroids.

Reference: eTG – 2025 – Nephrology; KDIGO – 2021 – IgA Nephropathy Guidelines