IgA Nephropathy is a relatively common chronic kidney disease as it affects millions of patients worldwide. It is a disease that affects the filters, or glomeruli, of the kidneys. The main symptom of IgA is the blood that shows up in the patient’s urine. Additionally, research shows that men get it at about twice as often as women for unknown reasons, and while it is sometimes found during childhood, it can also not be detected by a doctor until a patient has the symptoms of actual kidney failure.
The cause of IgA nephropathy is also not well understood. There may be genetic causes, but researchers are still trying to figure them out. There is sometimes a link with a different infection, leading to an autoimmune response that appears as IgA Nephropathy. In any case, the treatment options for this serious kidney disease remain limited. More research is needed to find new ways to treat the disease and symptoms to improve the quality of life for those diagnosed.
One of the major difficulties with the disease is that it progresses very slowly, if at all. It can take 20 years for it to even start causing symptoms. This means that research for treatments have been difficult to develop and has not allowed doctors to determine the best line of treatment. The options available fall into three major categories:
Most doctors agree that blood pressure control and limiting the amount of protein in the urine are primary goals in treating this chronic kidney disease. ACE-inhibitors (angiotensin converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) both help to reduce blood pressure and can limit the protein, effectively helping to achieve both goals. Unfortuantely, both ACE-inhibitors and ARBs come with a host of unfavorable side effects, including development of a chronic cough, red and itchy skin, dizziness, metallic taste or inability to taste, sore throat, chest pain, and even unfortunately kidney failure. It is important to note that despite these potential side effects, following the treatment protocols of your doctor who knows your best standard of care is paramount to your health.
Another commonly used agent is Fish Oil though studies do not agree on its true benefit. However, its lack of serious side-effects has many doctors recommending it.
Since this disease often presents as an over-stimulation of the immune system, 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. Of course, long-term steroid use is also associated with a host of side-effects.
Some of the patients diagnosed with IgA nephropathy will eventually progress to renal failure. Fortunately, kidney transplant is a treatment option for these patients. Renal function often is significantly improved after transplant, and the symptoms are lessened. But a return of this disease is fairly common after a kidney transplant, though the degree of its progress is decreased and with improved monitoring after diagnosis.
Again, IgA will often progresses slowly. Doctors may simply do check-ups on some patients with normal renal function and minimal protein in the urine without starting any treatment therapy.
Forutunately for those living with this chronic kidney disease, there are several clincial trials in development looking for new investigational medications. One is atrasentan in the Chinook Align Study for patients with IgA which will start recruiting patients in late 2020. Many of these studies are investigating medications that help reduce protein in the blood while helping maintain kidney function.
As more research is done on the disease and potential treatments, the understanding of the disease and the best form of treatment will increase and doctors and patients together can make more informed decisions for care.