IgA nephropathy can take many variants. Classically, it can present as the nephritic syndrome but can be just benign hematuria with no other complaints. Sometimes it can be aggressive with crescents and or TMA. Proteinuria usually suggest a bad prognostic marker in IgA nephropathy. Sudden onset proteinuria might suggest a dual glomerular process or IgA nephropathy with a minimal change disease variant. A recent series of cases have been described in CJASN. A retrospective review of pathology cases in the Columbia Univ path database revealed 17 such cases. Most had normal creatinine, proteinuria was over 8g for average and biopsy showed co dominant IgA with mesangial deposits and MCD. 14/17 patients got complete remission with steroids and additional agents.
Another case presented in this case report.