Gross hematuria 1–2 d after URI, young adult
Hematuria only, no protein → no immediate therapy
Proteinuria / rising Cr → renal biopsy (mesangial IgA) → maximized ACEi/ARB + SGLT2 inhibitor (eGFR >20) ± sparsentan; BP target <120/70; at-risk threshold proteinuria ≥0.5 g/d — target <0.5 g/d, ideally <0.3 g/d (KDIGO 2025)
Order set
- Urinalysis (dysmorphic RBC/casts)
- U&E, urine PCR
- BP
- Renal biopsy if progressive
Criteria
AdmitRPGN, malignant HTN, or AKI
DialysisAEIOU if advanced
DischargeBP/proteinuria controlled, nephrology follow-up
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Rising creatinine
- Nephrotic-range proteinuria
- Hypertension
Differentials
- Post-infectious GN
- Alport
- Thin basement membrane
- Vasculitis
Common mistakes
- Missing rapidly progressive GN
- Not controlling BP/proteinuria
Disposition & follow-up
ACEi + BP control; immunosuppression if progressive; nephrology.
Discharge package
MedicationsACEi/ARB; BP control
Follow-upNephrology; monitor proteinuria/renal
Warning symptomsSwelling, reduced urine, visible haematuria
💊 Treatment detail — doses & preparation
LisinoprilACE inhibitor
DoseStart 2.5–5 mg OD, target 20–40 mg OD
Preparation2.5/5/10/20 mg tablets
MonitorCreatinine + K⁺ 1–2 wk after each titration
ImmunosuppressionKDIGO 2025
DosePersistent high-risk despite supportive care: targeted-release budesonide (Nefecon) 16 mg/d ×9 mo preferred first-line immunosuppression; if unavailable, reduced-dose systemic steroid (TESTING ~0.4 mg/kg/d methylprednisolone + PJP prophylaxis); cyclophosphamide reserved for RPGN only
PreparationPer nephrology
MonitorProteinuria, eGFR q3–6 mo
📖 KDIGO 2025 IgAN/IgAVReviewed July 2026