A 28-year-old man presents with a 3-week history of gross hematuria following an upper respiratory infection. He reports mild flank discomfort but denies arthralgia, abdominal pain, or rash. Vital signs are BP 138/88 mmHg, HR 88/min, temperature 37.0°C. Urinalysis shows 3+ proteinuria, dysmorphic RBCs, and RBC casts. Serum creatinine is 1.3 mg/dL (baseline unknown). Complement levels (C3, C4) are normal. Kidney biopsy demonstrates IgA-dominant immune deposits in the glomerular mesangium on immunofluorescence microscopy, with mesangial proliferation on light microscopy. Which of the following is the most significant long-term prognostic factor in this patient?
- A)The degree of proteinuria and presence of hypertension at presentationGABARITO
- B)Serum IgA level elevation
- C)The timing of hematuria onset relative to upper respiratory infection
- D)Presence of dysmorphic RBCs on urinalysis
- E)Normal complement levels
Explicação
In IgA nephropathy, proteinuria >1 g/day and hypertension at presentation are the strongest independent predictors of progression to end-stage renal disease. Patients with preserved renal function at diagnosis but significant proteinuria and hypertension face ... Ver explicação completa e trilha adaptativa →