IgA nephropathy – ACEi — RACP Paediatrics MCQ

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ModerateNephrologyIgA nephropathy – ACEiRACP Paediatrics

A 10-year-old with IgA nephropathy has persistent proteinuria (urine PCR 150 mg/mmol) with normal renal function and normal blood pressure. What is the most appropriate treatment to reduce proteinuria and preserve renal function?

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Correct answer: A — ACE inhibitor

An ACE inhibitor (or ARB) is the first-line treatment for persistent proteinuria in IgA nephropathy, even with normal blood pressure and renal function. It reduces proteinuria through a direct effect on glomerular haemodynamics (reducing intraglomerular pressure) and has been shown to slow progression. Immunosuppression is reserved for progressive disease despite optimal supportive care.

Reference: RCH Melbourne – 2023 – IgA Nephropathy CPG; KDIGO – 2021 – GN Guidelines