Unmasking tuberculosis triggered IgA nephropathy

Tuberculosis-triggered IgA nephropathy (TB-IgAN) is a rare but important renal manifestation that often goes unrecognised due to its non-specific presentation. We report the case of a woman in her 30s who presented with progressive oedema, decreased urine output, frothy urine, intermittent dark-coloured urine and a short history of productive cough. She was diagnosed with pulmonary Mycobacterium tuberculosis (MTB) and biopsy-confirmed IgAN, revealing TB-IgAN as the cause of her rapidly progressive kidney disease. This case highlights the importance of evaluating haematuria and proteinuria in patients with TB, as early identification of TB-related renal involvement (TB-IgAN in this case) can significantly alter the management of IgAN. Although a kidney biopsy is challenging in the context of active MTB, it remains essential for accurate diagnosis. MTB can manifest with atypical features and trigger immune-mediated renal complications such as IgAN, warranting a high index of suspicion in compatible clinical settings.