American Board of Internal Medicine (ABIM) Certification Practice Exam

Which management approach is appropriate for patients with IgA nephropathy who have low-risk features for progression?

1. Immediate initiation of immunotherapy

2. Observation with serial assessments

3. Referral to nephrology

4. Diet restriction

The correct answer is: Observation with serial assessments

For patients with IgA nephropathy exhibiting low-risk features for progression, the most appropriate management approach is observation with serial assessments. This approach is favored because these patients typically have a more favorable prognosis and are less likely to experience significant deterioration in kidney function. Monitoring allows for the identification of changes in the patient's condition without initiating aggressive treatments, which may not be necessary. In low-risk individuals, especially those with stable kidney function, mild proteinuria, and absence of hypertension, intensive treatments, such as immunotherapy or early referral to specialized care, may expose patients to unnecessary risks or side effects. The observation strategy enables clinicians to carefully track the patient's kidney function and manage any emerging concerns promptly, while avoiding overtreatment that could lead to adverse effects or complications. This approach balances safety and efficacy, ensuring that only those patients who demonstrate signs of progression or worsening symptoms are escalated to more invasive management strategies.