What is the treatment for IgA nephropathy?
There is no specific treatment to cure IgA nephropathy. However, there are many treatments that can help to protect the kidneys and so improve the outlook:
- It is very important to have regular blood pressure checks and to keep your blood pressure normal.
- It is also important to have regular urine checks to see if there is any protein or blood in the urine.
- Treatment needs to be started early if blood pressure levels become high. Treating high blood pressure levels helps to reduce any damage to the kidneys.
- Treatment with steroids is controversial but steroids may reduce the amount of protein leaking from the kidneys into the urine. Steroids may also reduce the risk of chronic kidney disease and kidney failure (end-stage kidney disease).
The medicines used for blood pressure control with IgA nephropathy are angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) - for example, losartan. Even if you don't have high blood pressure, Both ACE inhibitors and ARBs can reduce your risk of developing chronic kidney disease. Sometimes ACE inhibitors and ARBs are used together.
Steroids can also help to reduce the amount of protein in the urine and reduce your risk of chronic kidney disease.
Medicines called statins may be needed to treat high cholesterol. Your cholesterol may increase because of IgA nephropathy.
Other treatments that may help include other medicines to reduce your defence (immune) system (for example, azathioprine). Medicines that prevent blood clotting in your blood vessels (anticoagulants) have also been used. Removing your tonsils (tonsillectomy) may be used to reduce the amount of IgA in your bloodstream and so reduce any further damage to your kidneys.
If you develop chronic kidney disease, this may become severe (end-stage kidney disease). You will then probably need treatment with dialysis and a kidney transplant. Most people with IgA nephropathy do not develop chronic kidney disease. There is a risk of the transplanted kidney becoming affected by IgA nephropathy.
Further reading and references
Lai KN, Leung JC, Tang SC; Recent advances in the understanding and management of IgA nephropathy. F1000Res. 2016 Feb 115. pii: F1000 Faculty Rev-161. doi: 10.12688/f1000research.7352.1. eCollection 2016.
Lv J, Xu D, Perkovic V, et al; Corticosteroid therapy in IgA nephropathy. J Am Soc Nephrol. 2012 Jun23(6):1108-16. doi: 10.1681/ASN.2011111112. Epub 2012 Apr 26.
Reid S, Cawthon PM, Craig JC, et al; Non-immunosuppressive treatment for IgA nephropathy. Cochrane Database Syst Rev. 2011 Mar 16(3):CD003962. doi: 10.1002/14651858.CD003962.pub2.
Vecchio M, Bonerba B, Palmer SC, et al; Immunosuppressive agents for treating IgA nephropathy. Cochrane Database Syst Rev. 2015 Aug 3(8):CD003965. doi: 10.1002/14651858.CD003965.pub2.
Cheng J, Zhang X, Tian J, et al; Combination therapy an ACE inhibitor and an angiotensin receptor blocker for IgA nephropathy: a meta-analysis. Int J Clin Pract. 2012 Oct66(10):917-23. doi: 10.1111/j.1742-1241.2012.02970.x.
Kamei K, Nakanishi K, Ito S, et al; Long-term results of a randomized controlled trial in childhood IgA nephropathy. Clin J Am Soc Nephrol. 2011 Jun6(6):1301-7. doi: 10.2215/CJN.08630910. Epub 2011 Apr 14.
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