How does IgA nephropathy typically present and what is a key histologic feature?

• A. Recurrent Gross Hematuria or Microscopic Hematuria After Mucosal Infection; Mesangial Proliferation With IgA Deposition on Immunofluorescence
• B. Progressive Edema and Proteinuria; Podocyte Effacement
• C. Nephrotic Syndrome With Hypoalbuminemia; Subepithelial Immune Complex Deposits
• D. Asymptomatic Proteinuria Only; Interstitial Fibrosis

Answer: (A)

IgA nephropathy typically shows episodic hematuria that occurs after mucosal infections (often upper respiratory or gastrointestinal), meaning you’ll see visible blood in the urine or microscopic blood in a pattern linked to infections. The histologic hallmark is mesangial proliferation with IgA-dominant deposition in the mesangium on immunofluorescence. This combination—recurrent hematuria post-infection plus mesangial IgA deposition—is characteristic and helps distinguish it from other glomerulonephritides.

The other scenarios don’t fit as well because they describe patterns more typical of nephrotic syndromes or chronic tubulointerstitial disease: heavy edema and prominent proteinuria with podocyte changes point toward minimal change disease or FSGS; subepithelial immune deposits after infection suggest post-infectious or membranous processes; and asymptomatic proteinuria with interstitial fibrosis implies a chronic, non-hematuria-dominated course.