Free nephrology board questions: Primary GN

A 70-year-old woman is diagnosed with ANCA-associated glomerulonephritis. Among the following clinical factors, which is most strongly associated with progression to kidney failure?

A 45-year-old man is diagnosed with anti-GBM (Goodpasture) disease. Which factor at presentation is most predictive of the likelihood of renal recovery?

A 35-year-old woman with IgA nephropathy has stable kidney function (eGFR 90 mL/min/1.73 m2) and proteinuria of 0.5 g/day on a maximally tolerated ACE inhibitor. According to the KDIGO 2025 guideline, what is the recommended approach to systemic glucocorticoid therapy?

A 31-year-old man is evaluated for persistent hematuria and proteinuria found on a routine physical, with a history of two episodes of gross hematuria during upper respiratory infections. Serum creatinine is 1.1 mg/dL (eGFR 82 mL/min/1.73m2) and urine protein:creatinine ratio is 0.85 g/g. Biopsy confirms IgA nephropathy (Oxford MEST-C: M1 E0 S1 T0 C0). After 3 months of maximally tolerated RAS blockade with blood pressure well controlled, his proteinuria remains 0.7 g/g. Which of the following is the most appropriate next step per the KDIGO 2025 IgA nephropathy guideline?

A 32-year-old man is found to have IgA nephropathy on kidney biopsy (mild mesangial hypercellularity). His eGFR is 65 mL/min/1.73 m2, urine protein is 0.9 g/day, and he has hypertension. According to the KDIGO 2025 IgAN guideline, which is the most appropriate initial management step?

A 43-year-old man presents to the nephrology clinic for ongoing management of IgA nephropathy. Four months ago, microscopic hematuria and 2+ proteinuria were detected during an insurance evaluation. An office BP at that time was 135/85 mm Hg. A 24-hour urine collection revealed 1.1 g protein (reference range, <100 mg/24 h). Serum creatinine was 0.9 mg/dL (reference range, 0.7–1.3). Kidney biopsy revealed IgA nephropathy with mild mesangial hypercellularity, but no crescents, interstitial fibrosis, or tubular atrophy (MEST-C score M1, E0, S0, T0, and C0). Home BP monitoring was instituted, and hypertension was diagnosed based on an average BP of 138/83 mm Hg. Lisinopril 20 mg/day was initiated 1 month ago. Today, the patient feels well, and brings a home BP log with average readings of 130/78 mm Hg and heart rate of 65/min. Physical examination is unremarkable. Spot urine protein-to-creatinine ratio (UPCR) is 1.2 mg/mg (reference range, <0.2). Which ONE of the following is the next BEST STEP in management?

A 28-year-old woman presents with sudden periorbital and pedal edema, nephrotic-range proteinuria (8 g/day), and hypoalbuminemia (1.9 g/dL). There is no hematuria and kidney function is normal. Biopsy shows normal light microscopy, negative immunofluorescence, and diffuse podocyte foot-process effacement on electron microscopy, confirming minimal change disease. She receives prednisone 1 mg/kg/day. After 16 weeks of full-dose therapy her proteinuria has fallen only to 3.5 g/day. Which of the following best characterizes her disease, and what is the next step?

A 45-year-old man with IgA nephropathy and CKD stage 3a (eGFR 55 mL/min/1.73 m2) has persistent proteinuria of 1.0 g/day on a maximally tolerated ACE inhibitor. According to the KDIGO 2025 guideline, which add-on therapy best reduces proteinuria and slows CKD progression?

A 38-year-old woman with IgA nephropathy has persistent proteinuria of 2.2 g/day despite maximally tolerated RAS blockade and optimized supportive care. Which of the following agents demonstrated a significant reduction in proteinuria in a phase 3, placebo-controlled trial in IgA nephropathy?