Do you treat persistent microscopic hematuria as a clinically meaningful sign of ongoing disease activity in a patient with IgA nephropathy whose proteinuria is well controlled on current therapy?

How do you approach persistent microscopic hematuria in a patient with IgA nephropathy whose proteinuria is well controlled on current therapy?

• I consider it a clinically meaningful sign of ongoing glomerular inflammation and factor it into treatment decisions alongside proteinuria and eGFR trajectory
• I monitor it closely but do not escalate therapy based on hematuria alone if proteinuria remains well controlled
• I use it as a trigger to reassess disease activity with repeat biopsy before considering treatment escalation
• I do not consider persistent microscopic hematuria a sufficient indicator of disease activity to modify therapy in the absence of rising proteinuria or declining eGFR
• Other