Managing IgA Nephropathy usually involves a combination of healthy lifestyle choices and medications, many of which are used for other reasons; so while these medications aren’t specifically for IgA Nephropathy, they’ve been shown to help ease symptoms. Sometimes there is a clear recommendation for treatment, and in other cases, you might be given a choice between different therapies.
Taking the time to understand all of the treatment options for managing IgA Nephropathy and when each might be recommended. Doing so can help you ask the right questions and advocate for yourself, especially if there are avenues that better suit your needs or comfort level. Keep in mind, that there are a number of factors that will come into play as you and your health care providers map out the best course of treatment for you both now and in the future.
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Factors that can shape treatment decisions
- Your medical history, including other health conditions.
- Your blood pressure.
- How much protein is in your urine? Protein circulates in your blood, but it’s not usually found in the urine. Having protein in the urine (called proteinuria or albuminuria) can be a sign of kidney damage.
- Your estimated glomerular filtration rate (eGFR), a measure of how much blood your kidneys filter each minute that can help gauge how well your kidneys are working; your eGFR helps to know what stage of kidney disease you are in. Stages of kidney disease range from mild loss of kidney function to complete kidney failure that requires dialysis or transplant.
- Results from the biopsy used to confirm IgA Nephropathy. This can show the extent of inflammation and scarring in your kidneys.
- Other treatments you’ve tried and how you responded.
- Your goals and hopes for the treatment.
Your provider might use a calculator of sorts to plug in information and help determine how quickly your condition may progress. This can also help to guide treatment decisions.
Overview of treatment options
A healthy lifestyle can help manage IgA Nephropathy. For example:
Eating healthy—Keep your food choices low-sodium (which can help reduce fluid retention), focus on making plant-based foods the main feature of your meals, and limit heavy meals
Getting regular physical activity
Maintaining a healthy weight
Managing stress and getting high-quality sleep
Not using tobacco
Ask your nephrologist where to start and try not to make too many changes at once.
Medications are coupled with lifestyle changes to help protect the kidneys and help you feel better. Most people with IgA Nephropathy take several medications. They can help:
Reduce protein in the urine.
Lower blood pressure to help protect the kidneys. Not only can high blood pressure damage the kidneys, but the effects of IgA Nephropathy can raise blood pressure too, placing continued strain on the kidneys. Blood pressure medicines called ACE-inhibitors (medications ending in -pril) or an ARBs (medications ending in -sartan) are commonly used, ideally at the highest dose you can take. Other medications might be added to meet your blood pressure goal, including spironolactone or Aldactone. These also help to reduce the amount of protein in the urine. People with IgA Nephropathy are often asked to monitor their blood pressure daily.
Remove excess fluid in the body with diuretics, also called water pills. Because the kidneys aren’t working as well, your body may hold onto fluid and you may notice puffiness or swelling in your legs or ankles (called edema). Diuretics help the body excrete the fluid through the urine.
Lower the chance of poor outcomes, including hospitalizations or the need for advanced therapies. SGLT2 inhibitors, which were initially developed for diabetes, are increasingly being used to slow the progression of kidney disease and protect the kidneys.
Reduce blood cholesterol levels to slow the progression of kidney damage and heart or blood vessel disease. Over time, cholesterol can build up in the artery walls, making it harder for your blood to flow freely. A statin is often started first and other non-statin treatments may be added.
Calm the body’s immune system and reduce inflammation, generally by prescribing a corticosteroid or similar medication. The use of systemic steroids is suggested, but not recommended based on clinical guidelines, so it’s important to carefully review the pros and cons of using them and the choice is very individual. Newer medicines are designed to target treatment to localized areas of the gut where the condition is thought to originate.
Treat complications of kidney disease, such as anemia (low red blood cell count), bone disease, heart disease, or acidosis (a build-up of acid in the blood); erythropoietin stimulating agents or iron supplements may be used to treat anemia. Vitamin D supplements can help support immune and bone health.
If you have advanced kidney disease, you’ll need to learn about and consider dialysis or kidney transplantation.