A 35-year-old man presents with hematuria and 4+ proteinuria following an upper respiratory infection 2 days ago (synpharyngitic nephritis). Complement C3 is normal. Renal biopsy shows mesangial IgA deposits. He has hypertension (BP 145/92) and proteinuria of 2.8 g/day. eGFR is 58 mL/min. Which therapy has the strongest evidence to slow CKD progression in this patient?
- A High-dose oral corticosteroids (methylprednisolone pulse)
- B Tonsillectomy
- C ACE inhibitor or ARB targeting proteinuria <1 g/day ✓
- D Fish oil (omega-3 fatty acids) supplementation
Correct answer: C. ACE inhibitor or ARB targeting proteinuria <1 g/day
Explanation
In IgA nephropathy, the most evidence-based intervention for renoprotection is achieving proteinuria <1 g/day through optimized renin-angiotensin system blockade (ACE inhibitor or ARB). The STOP-IgAN and TESTING trials showed that immunosuppression adds significant side effects without clear benefit in patients with proteinuria controlled by RAS blockade. Supportive care with RAS blockade, BP control, and SGLT2 inhibitors (now emerging) forms the backbone. Tonsillectomy and fish oil have insufficient evidence for routine use.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.