IgA Nephropathy

Advanced MCQs for Nephrologists

Assess advanced clinical reasoning in IgA nephropathy pathology, Oxford MEST-C risk assessment, supportive care, rapidly progressive disease, and treatment decisions.

IgA Nephropathy — Advanced

Difficulty: Advanced

Test advanced clinical reasoning in IgA nephropathy pathology, Oxford MEST-C risk assessment, supportive care, rapidly progressive disease, and treatment decisions. This quiz contains 10 single-best-answer questions. Explanations are shown after quiz completion.

1 / 10

Which biopsy finding is most characteristic of IgA nephropathy on immunofluorescence microscopy?

Linear glomerular IgG deposition

Predominant mesangial IgA deposition

Full-house staining with C1q predominance

Purely subepithelial IgG4 deposits

2 / 10

A patient with biopsy-proven IgA nephropathy has persistent proteinuria of 1.2 g/day despite optimized blood pressure control and maximized ACE inhibitor therapy. What is the most appropriate next principle of management?

Immediate cyclophosphamide for all patients

No follow-up because proteinuria is below 2 g/day

Further optimize supportive care and assess progression risk before disease-specific therapy

Long-term high-dose glucocorticoids without risk assessment

3 / 10

Which histologic feature is included in the Oxford MEST-C classification of IgA nephropathy?

Linear IgG staining intensity

Anti-GBM antibody titer

Percentage of crescents only

Endocapillary hypercellularity

4 / 10

A patient with IgA nephropathy presents with rapidly declining eGFR, hematuria, and crescents in 35% of glomeruli. Which concern is most important?

Benign isolated microscopic hematuria

Rapidly progressive IgA nephropathy requiring urgent assessment for aggressive therapy

Minimal-change disease

Alport syndrome

5 / 10

Which clinical feature is associated with increased risk of progression in IgA nephropathy?

Transient hematuria that resolves completely

Normal blood pressure and stable eGFR

Persistent proteinuria and declining eGFR

Absence of proteinuria over repeated measurements

6 / 10

A patient with IgA nephropathy develops gross hematuria during an upper respiratory infection, followed by persistent microscopic hematuria. What pattern does this represent?

Post-streptococcal glomerulonephritis

Alport syndrome

Thin basement membrane disease exclusively

Synpharyngitic hematuria

7 / 10

Which statement best describes the role of tonsillectomy in routine IgA nephropathy management?

It is mandatory for all biopsy-proven cases

It is not routine therapy and should not replace optimized nephroprotective care

It reliably prevents kidney failure in adults

It replaces renin–angiotensin system blockade

8 / 10

A patient with IgA nephropathy has nephrotic-range proteinuria, preserved eGFR, and biopsy showing minimal mesangial changes with diffuse foot-process effacement but no significant IgA deposits. Which alternative diagnosis should be considered?

Minimal-change disease with incidental or limited IgA deposits

Anti-GBM disease

Diabetic nephropathy

Amyloidosis as the only possibility

9 / 10

Which therapy is primarily aimed at reducing intraglomerular pressure and proteinuria in IgA nephropathy?

Cyclophosphamide

Rituximab in every patient

Plasma exchange

ACE inhibitor or angiotensin receptor blocker

10 / 10

Before considering systemic glucocorticoids in a high-risk IgA nephropathy patient, which assessment is particularly important?

Whether the patient has isolated microscopic hematuria only

Whether proteinuria has ever been measured

Infection risk, metabolic toxicity, eGFR, and whether supportive care has been optimized

Whether blood pressure is untreated

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