IgA Nephropathy — Viva

Opening (30 s)

"IgA Nephropathy — give a one-line definition and the single most important immediate risk."

Model: IgA nephropathy (Berger disease) is the commonest primary glomerulonephritis worldwide, defined by mesangial deposition of galactose-deficient IgA1 immune complexes. Classically presents with synpharyngitic gross haematuria 1 to 2 days after a mucosal infection. Diagnosis is renal biopsy showing dominant mesangial IgA on immunofluorescence. Foundation of management is RAAS blockade plus an SGLT2 i [1]

Station 1 — Pathophysiology (2 min)

Explain the mechanism chain from cause to clinical features and one major complication.

Station 2 — Clinical diagnosis (2 min)

Classic presentation, atypical groups, named bedside signs, and what you examine for red flags.

Red flag cue: Unstable or complicated IgA Nephropathy [1]

Station 3 — Investigations (2 min)

First-line tests, definitive tests, and any named score with exact components.

Station 4 — Emergency management (3 min)

ABC priorities, first drugs with dose and route, procedures, and when to escalate to ICU/theatre.

Station 5 — Definitive / long-term care (2 min)

Stepwise definitive therapy, monitoring, complications of treatment, follow-up.

Station 6 — Special populations (2 min)

Child / pregnancy / elderly / immunocompromised / renal impairment — what changes.

Station 7 — Evidence & pitfalls (2 min)

Landmark trial or guideline name if standard; three classic exam traps.

Station 8 — Rapid-fire pearls (1 min)

Five high-yield facts a candidate must not forget under time pressure.

Examiner pass criteria

• Speaks in mechanisms and numbers, not vague lists
• Gives at least one exact dose or threshold
• Names escalation criteria
• Avoids dangerous delays (imaging when unstable, etc.)

References

1. [1]Roberts IS. Pathology of IgA nephropathy. Nature Reviews Nephrology, 2014.PMID 24861083
2. [2]Cheung CK, Alexander S, Reich HN, et al. The pathogenesis of IgA nephropathy and implications for treatment. Nature Reviews Nephrology, 2025.PMID 39232245
3. [3]Lv J, Zhang H, Wong MG, et al. Effect of oral methylprednisolone on clinical outcomes in patients with IgA nephropathy: the TESTING randomized clinical trial. JAMA, 2017.PMID 28763548
4. [4]Rauen T, Eitner F, Fitzner C, et al. Intensive supportive care plus immunosuppression in IgA nephropathy. New England Journal of Medicine, 2015.PMID 26630142
5. [5]Lafayette RA, Canetta PA, Rovin BH, et al. Efficacy and safety of a targeted-release formulation of budesonide in patients with primary IgA nephropathy (NefIgArd): 2-year results from a randomised phase 3 trial. The Lancet, 2023.PMID 37591292
6. [6]Empa-Kidney Collaborative Group. Empagliflozin in patients with chronic kidney disease. New England Journal of Medicine, 2023.PMID 36331190
7. [7]Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney International, 2021.PMID 34556256
8. [8]Cattran DC, Coppo R, Cook HT, et al. The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney International, 2009.PMID 19571790
9. [9]Lv J, Wong MG, Hladunewich MA, et al. Effect of Oral Methylprednisolone on Decline in Kidney Function or Kidney Failure in Patients With IgA Nephropathy: The TESTING Randomized Clinical Trial. JAMA, 2022.PMID 35579642
10. [10]Rovin BH, Barratt J, Heerspink HJL, et al. Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled phase 3 trial. The Lancet, 2023.PMID 37931634