From Refractory to Remission: A Case of IgA Nephropathy with Nephrotic Syndrome Guided by Individualized Etiological Investigation

This report details a case of IgA nephropathy (IgAN) with nephrotic syndrome (NS), preceded by symptoms of acute pharyngitis. Despite mild renal pathological lesions, the condition proved refractory to conventional pharmacological interventions, including immunosuppressants and corticosteroids. An empiric tonsillectomy led to clinical remission of the nephrotic syndrome, although hypercholesterolemia persisted for approximately four years. This residual hypercholesterolemia was subsequently resolved through targeted lifestyle modifications involving exercise and dietary adjustments. Based on this diagnostic and therapeutic journey, we emphasize the critical importance of individualized etiological analysis and tailored interventions in managing refractory IgAN. Furthermore, this case serves as a paradigm, highlighting the potential value of a meticulous, etiology-oriented approach in the management of complex chronic diseases beyond nephrology.