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An 18-year-old girl, 15 weeks pregnant, presented to our hospital for the evaluation of headache. Her history was significant for immunoglobulin A (IgA) nephropathy, with a baseline serum creatinine of 1.8 mg/dl. She had been diagnosed with IgA nephropathy at 11 years of age after presenting with an elevated creatinine and microscopic hematuria. Her renal biopsy at the time showed mild mesangial proliferation with mesangial IgA deposits. The patient was not undergoing any therapy for her IgA nephropathy before her pregnancy.The patient had no complaints other than headache. Her physical examination revealed a blood pressure of 162/109 mm Hg with normal mental status. The rest of her physical examination was unremarkable. Her laboratory workup was the following: creatinine, 8.5 mg/dl (0.6-1.1); blood urea nitrogen, 83 mg/dl (6-21); potassium, 6.1 mmol/l (3.6-5.2); hemoglobin, 10.4 g/dl (12.0-15.5); platelets, 223Â10 9 /l (150-450Â10 9 ); aspartate aminotransferase, 23 U/l (8-43); alanine aminotransferase, 40 U/l (7-45); total bilirubin, 0.2 mg/dl (0.1-1.0); and international normalized ratio, 0.9 (0.8-1.2). Urine microscopy showed 21-30 RBC/ high-power field and occasional granular casts. A renal biopsy was performed for further evaluation of her renal failure (Figure 1a-c).

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