History Four years ago, a 23-year-old male had undergone a renal biopsy that revealed diffuse proliferative glomerulonephritis with no crescents. 30% of his glomeruli were obsolescent, with mild to moderate interstitial fibrosis. The electron microscopy detected electron-dense deposits within the mesangium, and IgA nephropathy was diagnosed. The patient was treated with an angiotensin receptor blocker (ARB), and his blood pressure at that time was between 120-125/70 mmHg.
During this period, his serum creatinine transiently increased from 0.9 mg/dl to 2.0 mg/dl, each occurring during synpharyngitic flares of his disease. One year ago, he had another synpharyngitic flare with a flu-like illness despite influenza vaccination, resulting in another gross hematuria episode. Due to this episode, serum creatinine increased to 1.3 mg/dl. Current Status Serum creatinine: 1.4 mg/dl Persistent…
