A 36-year-old woman was seen in renal clinic for follow up of chronic kidney disease (CKD) due to immunoglobulin A nephropathy (IgAN). She has been treated conservatively with lisinopril and fish oil. Her blood pressure is consistently below 120/70 mmHg on current dose of lisinopril. She feels well and denies any gross hematuria or swelling. She exercises regularly and tries to incorporate plant-based protein and gluten-free foods into her diet. Her kidney function is relatively stable with slow gradual decline over the years. One year ago, her serum creatinine was 0.9 mg/dL and cystatin C was 1.0 mg/L, with an estimated glomerular filtration rate (eGFR) of 83 mL/min/1.73m2 per the CKD-EPI creatinine-cystatin equation. Today, her serum creatinine is 1.0 mg/dL and cystatin C is 1.1 mg/L, with an eGFR of 73 mL/min/1.73m2. Urine protein-to-creatinine ratio is 0.55 g/g. Urinalysis showed trace blood.
