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Questions about kidney disease? Risk factors? Signs and symptoms? Are you concerned about yourself, a friend or family member? Ask Dr. Spry.
In many parts of the world, IgA nephropathy is the most common form of glomerulonephritis--a disease that damages the tiny filtering units of the kidney, called glomeruli. The damage caused by IgA nephropathy results from abnormal deposits of a protein called "IgA" in the glomeruli.
One of the kidney's most important jobs is to filter toxic waste products from the blood, and the glomeruli play a key role in this process. As more glomeruli are damaged by the IgA protein, the kidney progressively loses its ability to clear wastes from the body. In some patients with IgA nephropathy, this loss of kidney function progresses to chronic kidney failure, which requires dialysis treatment or a kidney transplant.
IgA Nephropathy is sometimes called "Berger's Disease," because a French physician named Berger was one of the first to describe the disease.
The most common sign is blood in the urine. The amount of blood may be so small that it is only visible with the aid of a microscope. Another common sign is swelling of the feet.
As loss of kidney function progresses, symptoms may include pain in the back below the ribs, increased need to urinate (especially at night), fatigue, nausea, swelling of hands and feet and high blood pressure.
The causes of IgA nephropathy are not well understood. The disease seems to cluster in certain families and in certain areas of the world. It rarely occurs in people of African heritage. These facts suggest that genetic influences may play a role in the development of the disease.
The presence of blood or protein in the urine are a possible sign of IgA nephropathy. To confirm this diagnosis, it is necessary to do a biopsy. The doctor removes a small piece of tissue from the kidney and examines it under a microscope to look for the characteristic IgA deposits in the glomeruli.
Efforts to slow the progression of kidney damage may include limiting the amount of protein in the diet and careful control of high blood pressure, if present. In addition, a recent study suggested that taking fish oil supplements may help to slow the loss of kidney function. For patients who develop progressive kidney failure, treatment may consist of dialysis or a kidney transplant.
The success rate of transplants is good in these patients. Even though the IgA deposits reappear in the transplanted kidney in about half the patients within one year after the operation, the signs and symptoms of the disease remain mild. Loss of a transplanted kidney to recurrent IgA nephropathy is uncommon. The milder form of the disease seen after transplantation may be due to the use of anti-rejection drugs such as cyclosporine.
Twenty to forty percent of the patients develop end stage kidney failure about 20 years after the disease becomes apparent. Patients who have an increased level of creatinine in their blood at the time of their diagnosis are more likely to develop chronic kidney failure. It is harder to predict which of the patients who have normal levels of creatinine at the time of diagnosis will develop kidney failure. In general, a poor prognosis is expected for those patients who have high blood pressure, a loss of more than two grams of protein a day in their urine and a significant amount of damage present in their biopsy specimen.
Several centers in the United States and other countries are studying IgA nephropathy. Researchers are investigating the chemical composition of the IgA protein, the rate of production of this protein, possible genetic influences and analysis of the long-term clinical outcome. Cooperative treatment trials on the effectiveness of the drug prednisone are continuing in the United States . Researchers recently completed a study of the effectiveness of fish oil supplements in slowing of the disease. They reported that fish oil supplements significantly slowed loss of kidney function in patients with IgA nephropathy.
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©2013 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. No one associated with the National Kidney Foundation will answer medical questions via e-mail. Please consult a physician for specific treatment recommendations.