Nephrology: IgA nephropathy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Nephrology: IgA nephropathy

Sample item

A 22-year-old man has an episode of painless macroscopic haematuria one day after a sore throat, his third similar episode. Blood pressure is normal, and serum C3 and C4 are normal. A renal biopsy would most likely show which immunofluorescence finding?

AGranular subepithelial IgG and C3 depositsBDominant mesangial IgA depositionCNegative immunofluorescence stainingDLinear IgG staining along the basement membrane

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Dominant mesangial IgA deposition

IgA nephropathy is the commonest primary glomerulonephritis worldwide. Macroscopic haematuria occurs within 1 to 2 days of a mucosal infection, unlike the 1 to 3 week latency of post-streptococcal disease, and complement levels are normal. Biopsy shows mesangial proliferation with dominant mesangial IgA, usually with C3.

Option by option

A. Granular subepithelial IgG and C3 deposits
Granular subepithelial IgG and C3 deposits describe post-infectious or membranous disease.
B. Dominant mesangial IgA deposition (correct)
Correct. Mesangial IgA deposits define the disease.
C. Negative immunofluorescence staining
Negative immunofluorescence is expected in thin basement membrane disease or minimal change disease.
D. Linear IgG staining along the basement membrane
Linear IgG staining is the pattern in anti-GBM disease, which causes rapidly progressive glomerulonephritis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Dominant mesangial IgA deposition. IgA nephropathy is the commonest primary glomerulonephritis worldwide.

Why is "Granular subepithelial IgG and C3 deposits" not the answer?

Granular subepithelial IgG and C3 deposits describe post-infectious or membranous disease.

Why is "Negative immunofluorescence staining" not the answer?

Negative immunofluorescence is expected in thin basement membrane disease or minimal change disease.

Why is "Linear IgG staining along the basement membrane" not the answer?

Linear IgG staining is the pattern in anti-GBM disease, which causes rapidly progressive glomerulonephritis.

What concept does this question test?

It tests Nephrology: IgA nephropathy in General Medicine. Macroscopic haematuria occurs within 1 to 2 days of a mucosal infection, unlike the 1 to 3 week latency of post-streptococcal disease, and complement levels are normal. Biopsy shows mesangial proliferation with dominant mesangial IgA, usually with C3.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nephrology: IgA nephropathy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.