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IgA Nephropathy, or Berger's Disease, is a chronic disease in which immunoglobulin A (IgA) deposits in the kidneys, causing kidney damage.
What is IgA nephropathy?
IgA nephropathy is a disease in which immunoglobulin A (IgA) — a form of antibody normally found mostly on mucous membranes, such as lining the mouth and intestines — deposits in the kidneys, causing kidney damage. The kidneys are then less able to filter waste from the blood.
Symptoms include blood in the urine, frothy urine, high blood pressure and swelling of the body. Symptoms of liver disease, such as a yellowing of the skin or eyes, nausea or vomiting, itching, and abnormal blood vessels may be present. Symptoms of celiac disease are also possible, which involves abdominal pain, bloating, indigestion, and diarrhea.
Treatments include regular follow-ups with your physician, medications to manage blood pressure, heart disease or kidney damage, dialysis, and if necessary, a kidney transplant.
You should visit your primary care physician. IgA nephropathy is treated with blood pressure medications, omega-3 fatty acids, immunosuppressants, and cholesterol-lowering medications (statins). In rare, progressed cases, dialysis or kidney transplant may be necessary.
Symptoms of IgA nephropathy
Symptoms of IgA nephropathy can be categorized by urinary and kidney symptoms, symptoms appearing with chronic liver disease, and symptoms of celiac disease.
Urinary and kidney symptoms
The following symptoms can be associated with the renal system, such as:
- Blood in the urine (hematuria): Some people with IgA nephropathy will develop one or more episodes of blood in the urine. The bloody urine is usually painless but can be associated with some discomfort in the flank area. These episodes can sometimes occur after a respiratory infection or episode of tonsillitis.
- Frothy urine: Some people can develop frothy urine. This occurs because damage to the kidneys causes protein to leak into the urine.
- High blood pressure (hypertension) and swelling of the body (edema): Less commonly, IgA nephropathy can cause rapid damage to the kidneys that causes high blood pressure and swelling of the entire body. This can happen suddenly and occur at the same time as seeing blood in the urine.
Symptoms of Chronic Liver Disease
In some cases, IgA nephropathy can be associated with chronic liver disease, causing symptoms such as:
- Jaundice: A yellowing of the skin or of the whites of the eyes
- Edema: Swelling of the abdomen or legs
- Nausea or throwing up
- Abnormal blood vessels on the skin
- Easy bruising or bleeding
Symptoms of Celiac Disease
In some cases, IgA nephropathy can be associated with celiac disease, in which people are unable to tolerate the gluten found in bread and other grain-based foods. When people with celiac disease eat gluten, they develop:
Causes of IgA nephropathy
The specific cause of IgA nephropathy is unknown. Factors that are thought to contribute to the development of IgA nephropathy include:
- Increased production of abnormal IgA: People with IgA nephropathy have increased levels of an abnormal form of IgA. These IgA molecules are known as "poorly glycosylated IgA," and this form of IgA is more likely to deposit in the kidneys.
- Decreased removal of IgA: Normally, there are processes in the body that help remove IgA from the blood. Impairment in these removal processes is thought to contribute to the development of IgA nephropathy. Some studies show that the liver helps remove IgA from the blood, so decreased liver function may contribute to the development of IgA nephropathy. Some studies also show that the kidney itself helps remove IgA from the blood, other kidney diseases may contribute to the development of IgA nephropathy.
- Certain infections: In some cases, IgA nephropathy has been known to develop after exposure to certain infections. These include bacteria that cause certain respiratory infections, as well as certain viruses. It is believed that the infections themselves do not cause IgA nephropathy; rather, the infections cause an imbalance in the immune system that then results in IgA nephropathy.
- Genetic mutations: Certain genetic mutations are thought to increase the risk of developing IgA nephropathy. This is because IgA nephropathy has been found to be more common in certain families. These genetic mutations may increase the risk of developing IgA nephropathy by creating an imbalance in the immune system.
Treatment options and prevention for IgA nephropathy
IgA nephropathy is a chronic disease that cannot be cured. One in four people with IgA nephropathy will eventually develop kidney failure. Therefore, treatments are focused on monitoring disease progression and slowing the rate of progression, as well as treating associated IgA nephropathy symptoms. Specific treatments include regular follow-ups, medications to manage blood pressure, heart disease or kidney damage, dialysis, and if necessary, a kidney transplant. Seeing your physician regularly every six to 12 months
If you notice blood in your urine, or your physician notices blood or protein in your urine (proteinuria) on a laboratory test, you should see your physician regularly at least once every six to 12 months. He or she can order lab tests to monitor disease progressionand determine if you need to start any treatments.
Medications for blood pressure and to limit kidney damage
If you develop high blood pressure or enough damage to your kidneys, your physician may recommend that you start a medication to lower your blood pressure and slow the progression of kidney damage. Possible medications include: lisinopril (Prinivil), enalapril (Vasotec), ramipril (Altace) or losartan (Cozaar).
Medications to lower your risk of heart disease
If IgA nephropathy damages your kidneys, you can develop an increased risk of heart disease. Therefore, your physician may recommend you take certain medications to lower your risk of heart disease. These include:
- Statins: Such as atorvastatin (Lipitor) or rosuvastatin (Crestor)
- Fish oil supplements
Medications to reduce kidney inflammation
If IgA nephropathy is causing rapidly-developing kidney damage, your physician may recommend you take certain medications to reduce the inflammation in the kidneys. These include:
- Steroids: Such as prednisone (Deltasone) or methylprednisolone (Medrol)
- Immunosuppressants: Such as cyclophosphamide (Procytox) or azathioprine (Imuran)
If enough damage occurs to your kidneys such that they are unable to perform their normal function, your physician may recommend that you begin dialysis, which is a treatment that performs the function of the kidneys. Usually, dialysis is only performed until a kidney transplant can be performed. There are two main forms of dialysis.
- Peritoneal dialysis: A tube is placed into the abdomen and fluid is exchanged through a membrane in the abdomen.
- Hemodialysis: A tube is placed into a blood vessel in the arm, and fluid is exchanged in a machine connected to the tube.
The best long-term treatment for a damaged kidney in IgA nephropathy is with a kidney transplant.
- Details: This surgery replaces your kidney with a healthy one from a donor. The new kidney from the donor will no longer have IgA nephropathy.
- Prognosis: It is possible to develop IgA nephropathy again, especially if you have a genetic mutation or other conditions that increase your risk of developing IgA nephropathy.
When to seek further consultation for IgA nephropathy
If you develop any symptoms of IgA nephropathy, such as blood in your urine, frothy urine, or swelling in your body, especially after a recent episode of an upper respiratory infection, you should see your physician. He or she can order laboratory tests to evaluate if you may have developed IgA nephropathy and recommend treatments to prevent damage to your kidneys.
Questions your doctor may ask to determine iga nephropathy
- Have you experienced any nausea?
- Are you sick enough to consider going to the emergency room right now?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Has your fever gotten better or worse?
- Is your fever constant or come-and-go?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Liu received his medical degree from the University of Pennsylvania Perelman School of Medicine and is pursuing a career in ophthalmology. He graduated Phi Beta Kappa from Swarthmore College with a BA in biology. He has published research in multiple ophthalmology and healthcare journals and has received awards from Research to Prevent Blindness. In his free time, he enjoys running, biking, and spending time with his friends and family.
- IgA nephropathy (Berger's disease): Overview. Mayo Clinic.Published August 4, 2017. Mayo Clinic Link
- IgA nephropathy. National Institute of Diabetes and Digestive and Kidney Diseases. Published November 2015. NIDDK Link
- IgA nephropathy. American Kidney Fund. AKF Link
- IgA nephropathy (Berger's disease): Diagnosis & treatment. Mayo Clinic. Published August 4, 2017. Mayo Clinic Link
- Barbour S, Feehally J. An update on the treatment of IgA nephropathy. Curr Opin Nephrol Hypertens. 2017;26(4):319-326. NCBI Link