A 19-year-old man presented to an adult nephrology practice to establish care. He had a history of recurrent hematuria and proteinuria in the setting of upper respiratory tract illnesses. This was first noted at age 14 when he had gross hematuria associated with episodes of fever and pharyngitis 2 months apart. Pharyngeal swab was negative for Streptococcus both times. He felt generally well otherwise. His pediatrician suspected IgA nephropathy (IgAN) and referred him to a pediatric nephrologist, who reported the same impression and recommended a conservative management strategy.