American Board of Internal Medicine (ABIM) Certification Practice Exam

What treatment may benefit patients with IgA nephropathy and significant proteinuria?

1. Diuretics

2. ACE inhibitors or ARBs

3. Glucocorticoids without monitoring

4. Only dietary interventions

The correct answer is: ACE inhibitors or ARBs

In patients with IgA nephropathy and significant proteinuria, the use of ACE inhibitors or ARBs is beneficial due to their renoprotective effects. These medications work by blocking the renin-angiotensin-aldosterone system (RAAS), which helps to lower blood pressure and reduce proteinuria. By decreasing the glomerular pressure in the kidneys, they can help mitigate further kidney damage and preserve renal function over time. The effectiveness of ACE inhibitors or ARBs extends beyond just managing blood pressure; they can also improve kidney outcomes, particularly in patients with significant proteinuria. Research has shown that such treatment can lead to a reduction in proteinuria, which is an important marker of kidney damage in conditions like IgA nephropathy. Therefore, their use is considered a standard approach in managing these patients, especially those presenting with significant protein loss in the urine. Regarding the other treatments mentioned, diuretics may help manage fluid overload but do not directly target proteinuria or renal protection. Glucocorticoids can play a role in certain cases of IgA nephropathy, especially when there is evidence of significant inflammation, but their use requires careful assessment and monitoring due to potential side effects. Dietary interventions alone cannot adequately address the