IgA Nephropathy Treatment — RACP Adult Medicine MCQ
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Correct answer: A — Discuss a reduced-dose systemic glucocorticoid regimen with infection prophylaxis in a selected high-risk patient
Explanation lettering: B = shown as A · A = shown as B · E = shown as D · D = shown as E
B is correct. Persistent proteinuria despite a full supportive-care period identifies higher progression risk; reduced-dose systemic glucocorticoid therapy may be considered in carefully selected patients after explicit discussion of serious infection and other toxicities, with prophylaxis as appropriate. C has not shown routine benefit in primary IgA nephropathy. D is reserved for a true rapidly progressive crescentic course, not proteinuria alone. E overgeneralises inconsistent ethnicity-dependent evidence. A abandons proven supportive care for an unproven substitute. Targeted-release budesonide is a distinct regimen and should not be described as the TESTING intervention; local availability, eGFR, diabetes, obesity and infection risk materially affect the choice.
Reference: Kidney Health Australia: IgA nephropathy: https://kidney.org.au/resources/factsheets-and-photosheets/iga-nephritis-factsheet/ KDIGO: IgA nephropathy and IgA vasculitis guideline: https://kdigo.org/guidelines/iga-nephropathy/ Australian RACP: Divisional Written Examination: https://www.racp.edu.au/trainees/examinations/divisional-written-examination