When red eyes signal glomerular disease: IgA nephropathy presenting as recurrent episcleritis and scleritis

IgA nephropathy (IgAN) is a primary chronic glomerulopathy that can rarely present with extrarenal ocular manifestations. We describe three patients presenting with chronic, anterior ocular inflammation two with recurrent episcleritis and one with scleritis that significantly preceded the renal diagnosis. Subsequent baseline urinalysis unmasked active urinary sediment with microscopic dysmorphic hematuria and marked proteinuria (2.0-4.0 g/day), with renal impairment in two patients. Histopathological evaluation via renal biopsy confirmed IgAN in all cases, including one with crescent formation. Following systemic immunosuppressive therapy and optimized supportive care, all patients achieved complete resolution of ocular inflammation and significant renal recovery, with marked reductions in proteinuria. These cases underline the clinical association between recurrent episcleritis/scleritis and underlying IgAN. Incorporating simple, cost-effective urine dipstick screening into the routine workup of inflammatory eye disease is crucial for prompt diagnosis and preventing progression to chronic kidney disease.