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IgA nephropathy — ESENeph MCQ

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ModerateGlomerulonephritisIgA nephropathyESENeph

A 19-year-old man attends clinic after two episodes of cola-coloured urine within 24 hours of sore throats. Blood pressure is 126/74 mmHg and there is no oedema. Creatinine is 86 micromol/L, urine ACR is 38 mg/mmol and complement C3 is normal. Urine microscopy shows dysmorphic red cells without casts. What is the most likely diagnosis?

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Correct answer: E — IgA nephropathy

Synpharyngitic visible haematuria with normal complement and modest proteinuria is typical of IgA nephropathy. Post-streptococcal glomerulonephritis classically follows infection after a latent period and is associated with low C3. Thin basement membrane nephropathy causes persistent microscopic haematuria rather than episodic visible haematuria linked to mucosal infection. A useful pearl is that risk stratification in IgA nephropathy is driven by sustained proteinuria, eGFR trajectory and blood pressure.

Reference: KDIGO 2021 Glomerular Diseases Guideline