What Is The Treatment
This disease is common, but there is no single treatment about which all doctors agree. This is in part because of the disease tends to progress very slowly, if at all. Many of the drugs that could be used in treatment can be very harmful.
It is generally accepted that blood pressure control and limiting the amount of protein in the urine are of primary importance. Both of these goals can often be accomplished with the use of two types of blood pressure medications. ACE-inhibitors and ARBs both help to reduce blood pressure. Another commonly used agent is Fish Oil. Studies do not agree on its true benefit. However, its lack of serious side-effects leads many doctors to recommend it.
This disease is essentially an over-activation of the immune system. Therefore, many immunosuppressive drugs have been tried with varying success. The most widely used are steroids, given either through a needle, by mouth, or both for at least 6 months.
IgA often progresses slowly. Doctors may simply follow some patients with normal renal function and minimal protein in the urine without starting any therapy at all. It is the diseases generally slow progression that has made it difficult for doctors to decide on the one best treatment.
Treatment For Kidney Failure From Iga Nephropathy
If you have kidney failure from IgA nephropathy, you will need to go on dialysis or have a kidney transplant. A transplant is not a cure for any type of kidney disease, but is considered a treatment. After a transplant, it is possible the new kidney can eventually become damaged because of igA nephropathy. About 4 out of 10 transplanted kidneys in people with IgA nephrology eventually fail.
How Common Is Iga Nephropathy And Who Is More Likely To Get The Disease
IgA nephropathy is one of the most common kidney diseases, other than those caused by diabetes or high blood pressure.1
IgA nephropathy can occur at any age, although the first evidence of kidney disease most frequently appears when people are in their teens to late 30s.2 IgA nephropathy in the United States is twice as likely to appear in men than in women.3 While found in people all over the world, IgA nephropathy is more common among Asians and Caucasians.4
A person may be more likely to develop IgA nephropathy if
- he or she has a family history of IgA nephropathy or IgA vasculitisa disease that causes small blood vessels in the body to become inflamed and leak
- he is a male in his teens to late 30s
- he or she is Asian or Caucasian
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How Can I Slow Down My Iga Nephropathy
Points to Remember IgA nephropathy is one of the most common kidney diseases, other than those caused by diabetes or high blood pressure. In its early stages, IgA nephropathy may have no symptoms it can be silent for years or even decades. Once symptoms appear, the most common one is hematuria, or blood in the urine.
Should I Eat Less Protein If I Have Iga Nephropathy
Some healthcare providers recommend eating less protein if you have any type of kidney disease. Thats because proteins break down into products that your kidneys need to filter. Eating too much protein may overwork your kidneys and cause them to decline faster. But if you dont eat enough protein, you may end up with malnutrition, when your body doesnt get the nutrients it needs. A nutritionist can help you find a balanced diet for your needs. If youre on a low-protein diet, you may need regular blood tests to check your protein levels.
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What Are The Symptoms
Blood in the urine, either constant or occasional, is the most common finding in people with IgA. Sometimes this blood can become visible as well. Though when it does, the urine typically appears browner or cola colored, rather than bright red. Bouts of visible blood in the urine from this disease often occur during or immediately after other short-term illnesses, such as an upper respiratory infection.
In addition to blood in the urine, people with IgA can have protein in the urine as well. The amount of protein in the urine is generally less than 3.5g. It can sometimes result in significant leg swelling and fluid retention.
IgA can be suspected from blood or protein in the urine and other symptoms. But it can only be diagnosed by a kidney biopsy.
How Is Iga Nephropathy Treated
Researchers have not yet found a specific cure for IgA nephropathy. Once the kidneys are scarred, they cannot be repaired. Therefore, the ultimate goal of IgA nephropathy treatment is to prevent or delay end-stage kidney disease. A health care provider may prescribe medications to
- control a persons blood pressure and slow the progression of kidney disease
- remove extra fluid from a persons blood
- control a persons immune system
- lower a persons blood cholesterol levels
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How Can Doctors Tell If I Have Iga Nephropathy
If doctors find protein in your urine after having urine test test, they may suspect IgA nephropathy. Because other kidney problems can cause protein in your urine, the only way doctors can be sure you have IgA nephropathy is by performing a kidney biopsy. A kidney biopsy is a surgery where doctors take out a very small piece of tissue from your kidneys to look at it under a microscope.
You can find out you have IgA nephropathy at any age, but 8 out of 10 people with IgA nephropathy are diagnosed between ages 16 and 35. IgA nephropathy is rare in children.
Clinical Features During The Follow
Average levels of each clinical feature during the follow-up were calculated and compared. Figure shows an example of serial measurements of UA during the follow-up of one patient and the equation to calculate the TA-UA in current study . Similarly, TA-P, TA-Hb, TA-Alb and TA-TC of each patient were calculated by the same method. As shown in Fig. , there were remarkable differences in TA-P , TA-UA , TA-Hb , TA-Alb and TA-TC between cases and controls.
Fig. 1
Clinical features during follow-up. a, Serial measurements of proteinuria during follow-up in one patient and the definition of TA-P for this patient. Comparison of TA-P , TA-UA , TA-Hb , TA-Alb and TA-TC . Dotted lines present the normal range of each clinical feature. Median and interquartile range were presented in each figure
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What Does It Look Like
First, a quick look at the kidney. Most people have two kidneys, one on each side of their lower back. All of the blood in your body passes through your kidneys many times during the day. Each time blood goes through some of it gets filtered and cleaned by the glomeruli. This cleaning is how your body gets impurities out of the blood . Some of the cleaned blood becomes your urine. Urine isnt red like blood because the red blood cells, which give blood its color, are too big to fit through the filters. A glomerulus is just a tiny bag of blood containers through which blood gets filtered. All of the clean blood runs into tubes which eventually lead to your bladder.
The drawing below shows how this disease affects the kidney. Pictured is a single blood vessel from a kidney filter, shown in cross section. The red disks are red blood cells. They normally should remain inside the vessel itself .The IgA deposits have activated the immune system and damaged the vessel wall. Therefore, red blood cells are spilling out the bottom of the vessel and into the urine.
Mesangial immune deposits
Below is a picture, from the actual kidney biopsy of someone with IgA Nephropathy. Shown is a single filter in which the actual IgA deposits have been stained florescent green.
What Is The Outlook
The outlook is very variable from person to person.
- IgA nephropathy may get better on its own without any further problems.
- IgA nephropathy may continue unchanged for many years. You will then only need regular check-ups with urine and blood tests.
- About 1 in 3 people with IgA nephropathy develop chronic kidney disease.
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Risk Factors For Iga Nephropathy
Although the exact cause of IgA nephropathy is unknown, these factors might increase your risk of developing it:
- Sex: affects at least twice as many men as women.
- Ethnicity: more common in Asians and Caucasians.
- Age: most often develops between the late teens and late 30s.
- Family history: In some cases, IgA nephropathy appears to run in families, indicating that genetic factors contribute to the disease.
Corticosteroids And Immunosuppressants In Iga Nephropathy
Corticosteroids have been used for many years, but benefit is not well documented. One protocol uses methylprednisolone 1 g IV once a day for 3 days at the beginning of months 1, 3, and 5 plus prednisone 0.5 mg/kg orally every other day for 6 months. Another regimen uses prednisone beginning 1 mg/kg orally once a day with dose gradually tapered over 6 months.
Because of the risk of adverse effects, corticosteroids should probably be reserved for patients with any of the following:
-
Worsening or persistent proteinuria , especially if in the nephrotic range despite maximal ACE inhibitor or ARB therapy
-
Increasing serum creatinine level
Combinations of IV corticosteroids and cyclophosphamide plus oral prednisone are used for severe disease, such as proliferative or crescentic nephropathy. Evidence for mycophenolate mofetil is conflicting it should not be used as first-line treatment. None of these drugs, however, prevents recurrence in transplant patients. Immunosuppressive therapy should also be avoided in patients with advanced fibrotic kidney disease, which is not reversible.
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How Does Iga Nephropathy Affect The Kidneys
IgA nephropathy affects the kidneys by attacking the glomeruli. The glomeruli are sets of looping blood vessels in nephronsthe tiny working units of the kidneys that filter wastes and remove extra fluid from the blood. The buildup of IgA deposits inflames and damages the glomeruli, causing the kidneys to leak blood and protein into the urine. The damage may lead to scarring of the nephrons that progresses slowly over many years. Eventually, IgA nephropathy can lead to end-stage kidney disease, sometimes called ESRD, which means the kidneys no longer work well enough to keep a person healthy. When a persons kidneys fail, he or she needs a transplant or blood-filtering treatments called dialysis.
More information is provided in the NIDDK health topic, Glomerular Diseases Overview.
How Can I Take Care Of Myself If I Have Iga Nephropathy
If you have kidney disease such as IgA nephropathy, its important to:
- Limit sodium in foods to help lower blood pressure and reduce swelling.
- Eat foods low in saturated fat and cholesterol to reduce levels of fat in your blood.
- Lifestyle modification such as quitting smoking, diet and exercise, if needed, can also be beneficial.
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Study Design And Participants
This was an observational casecontrol study. Fifty end stage renal disease patients with the primary cause of IgAN and a short renal survival time of less than ten years after renal biopsy were enrolled in case group. One hundred IgAN patients with a renal survival time of more than ten years after biopsy were reviewed as control group. Patients enrolled in this study were given the diagnosis of primary IgAN between 1997 and 2012 in the First Affiliated Hospital of Wenzhou Medical University. Exclusion criteria for both groups included: renal biopsy conducted in other hospitals, a secondary cause of IgAN, such as Henoch-Schonlein purpura, systemic lupus erythematosus, chronic liver disease and other autoimmune disorders, aged < 18 years at biopsy and history of cardiovascular events, carotid artery surgery or any organ transplantation.
Whats The Outlook For People With Iga Nephropathy
Sometimes, IgA nephropathy gets better on its own. In rare cases, IgA nephropathy progresses rapidly. Kidney failure can result within a few years.
There isnt a cure for this condition. With the right treatment, people can keep their kidneys as healthy as possible and slow the diseases progression.
About 1 in 4 adults with IgA nephropathy eventually get ESRD. About 1 in every 10 to 20 children with IgA nephropathy develop ESRD.
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What Are Clinical Trials And Are They Right For You
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.
Lifestyle And Home Remedies
To help keep your kidneys healthier:
- Take steps to reduce your blood pressure. Keeping your blood pressure levels near normal can help slow kidney damage from IgA nephropathy. Healthy changes in your lifestyle â including limiting your salt intake, losing excess weight, being physically active, using alcohol in moderation and taking your blood pressure medications as prescribed â are ways to keep your blood pressure under control.
- Monitor your blood pressure at home. Note each reading and bring this record with you to your doctorâs appointments.
- Eat less protein. Reducing the amount of protein you eat and taking steps to decrease your cholesterol levels may help slow the progression of IgA nephropathy and protect your kidneys.
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How Do My Kidneys Work
The kidneys are part of your urinary system. Heres how they typically work:
- Kidneys: These bean-shaped organs are on each side of your spine. They filter your blood, removing waste and extra water. The waste and water leave your body as urine. The kidneys then reabsorb the water and chemicals that your body needs.
- Nephrons: The tiny filtering units in each kidney are called nephrons. Each kidney has about a million nephrons.
- Glomerulus and tubule: Each nephron contains these structures. The glomeruli are tiny blood vessels that filter blood. The tubules return what you need to your blood and remove waste.
What Causes Iga Nephropathy
Scientists think that IgA nephropathy is an autoimmune kidney disease, meaning that the disease is due to the bodys immune system harming the kidneys.
People with IgA nephropathy have an increased blood level of IgA that contains less of a special sugar, galactose, than normal. This galactose-deficient IgA is considered foreign by other antibodies circulating in the blood. As a result, these other antibodies attach to the galactose-deficient IgA and form a clump. This clump is also called an immune complex. Some of the clumps become stuck in the glomerulus of the nephron and cause inflammation and damage.
For some people, IgA nephropathy runs in families. Scientists have recently found several genetic markers that may play a role in the development of the disease. IgA nephropathy may also be related to respiratory or intestinal infections and the immune systems response to these infections.
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How Do Doctors Treat Iga Nephropathy
There is no cure for IgA nephropathy. The goal of treatment is to slow the damage to your kidneys and delay or prevent kidney failure. Your doctor will work with you to make a treatment plan.
Doctors treat IgA nephropathy with medicines that:
- Lower inflammation
- Help control your blood pressure
- Help remove extra fluid from your blood
- Lower your cholesterol
Your doctor may also recommend that you:
- Make changes in what you eat to lower the amount of protein, fat, sodium and cholesterol you take in
- Take in more or less fluids through drinks and some foods
- Lose weight
Your doctor will also do regular tests to keep track of your kidney health over time.
What Are The Symptoms Of Iga Nephropathy
The symptoms caused by IgA nephropathy are very variable from person to person. Many people with IgA nephropathy do not have any symptoms. IgA nephropathy is usually painless but sometimes an acute attack can cause pain over the kidneys and a feeling of sickness for a couple of days.
However, the damage to the filters of the kidneys may cause some blood to appear in the urine. Usually there is only a very small amount of blood in the urine. Therefore any traces of blood in the urine are often invisible and only detected on routine medical check-ups. In other cases there may be a lot more blood which you can see and comes in attacks every so often.
There may also be protein leakage from the kidneys. This may be slight and only detectable on urine tests. Occasionally, high levels of protein leakage cause swollen ankles, with very low levels of protein and high levels of cholesterol in your blood. This is called nephrotic syndrome.
Sometimes a flu-like illness causes an increase in IgA getting to the kidney. This can cause an increased amount of blood in the urine, which then clears after a few days.
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What Is Immunoglobulin A Nephropathy
IgA nephropathy, also known as Bergers disease, is a kidney disease that occurs when IgA deposits build up in the kidneys, causing inflammation that damages kidney tissues. IgA is an antibodya protein made by the immune system to protect the body from foreign substances such as bacteria or viruses. Most people with IgA nephropathy receive care from a nephrologist, a doctor who specializes in treating people with kidney disease.
What Are My Chances Of Getting Better
Some patients spontaneously undergo a complete remission of symptoms and never experience a loss of kidney function. More often, the symptoms will stabilize, or the disease will progress slowly. On average, at 20 years , 20% of patients will have moved to end stage kidney disease. This requires either dialysis or a kidney transplant.
Rarely, a more rapidly progressive type of IgA is seen on biopsy. In these patients, immediate and aggressive immunosuppression is generally needed.
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