• Keeping protein levels in the urine low is critical for slowing the progression of immunoglobulin A (IgA) nephropathy and improving outcomes.
• High blood pressure worsens kidney damage, so it’s important to maintain it within a healthy range through medication and lifestyle changes.
• Regular follow-ups to monitor kidney function help tailor treatment plans and manage the disease effectively.

Immunoglobulin A nephropathy is a type of kidney disease that can affect anyone. Getting the diagnosis can be scary and challenging, and you may wonder how living with IgA nephropathy may affect your life expectancy. This article will cover the six most important factors that have an impact on the outcome and prognosis of IgA nephropathy.

It’s important to note that the terms “outcome” and “prognosis” can refer both to how long it takes to progress to kidney failure and to life expectancy.

What Is IgA Nephropathy?

IgA nephropathy happens when immunoglobulin A, a type of antibody (immune disease protein), builds up in the kidneys and causes inflammation. Normally, immunoglobulins fight foreign bacteria or viruses. In IgA nephropathy, the IgA is defective, and the body mistakenly produces antibodies that attack IgA. These antibodies and IgA together form complexes (clumps) that get stuck in the kidneys and start harmful cellular reactions. Over time, this can lead to kidney damage.

Understanding the factors that influence the outcome of this disease can help people living with IgA nephropathy and their loved ones manage it better.

1. Proteinuria

Proteinuria occurs when there’s too much protein in urine. Normally, your kidneys filter waste but keep important substances, like protein, in your blood. When the kidneys are damaged, they can let protein slip into the urine.

High levels of protein in the urine are a sign of poor kidney function. Studies show that people with high proteinuria tend to have a worse prognosis over many years. Keeping proteinuria under control is crucial for improving outcomes.

Your nephrologist (kidney specialist) will monitor this condition by taking a urine sample to measure the levels of protein in your urine. Keeping track of proteinuria is important for managing kidney diseases like IgA nephropathy because it helps in adjusting treatments and preventing further kidney damage.

2. Renal Function at Diagnosis

When you have IgA nephropathy, your kidneys are already inflamed due to the buildup of IgA antibody complexes. Over time, the kidneys slowly get scarred and can’t properly remove waste from blood.

Keeping track of protein in the urine can help in adjusting treatments and preventing further kidney damage.

To manage this, your health care provider will monitor your estimated glomerular filtration rate (eGFR), which is a measure of how well your kidneys are filtering blood. A lower eGFR indicates worse kidney function.

Several factors are considered to calculate eGFR, including age, sex, race, height, weight, and creatinine level. Creatinine is a waste product found in blood that the kidneys usually filter out. By measuring the amount of creatinine in your blood, doctors can estimate how well your kidneys are working.

The eGFR at the time of diagnosis is important for determining disease severity. People with a lower eGFR have more advanced kidney damage and are at higher risk of progressing to kidney failure.

3. Blood Pressure

Blood pressure is the force of blood pushing against the walls of your arteries. Hypertension (high blood pressure) can put extra strain on the blood vessels in the kidneys. Over time, this strain can cause the vessels to become thickened and narrowed, reducing blood flow to the kidneys. As a result, the kidneys get less oxygen and nutrients, which can lead to further damage and scarring.

High blood pressure is both a cause and a consequence of kidney disease. In IgA neuropathy, controlling blood pressure is crucial because hypertension also worsens ongoing inflammation in the kidneys, speeding up the progression of kidney damage.

4. Kidney Biopsy Results

A kidney biopsy is the only way to diagnose IgA nephropathy. This procedure involves taking a small sample of kidney tissue to look at under a microscope. The results can show how much damage there is and what kind.

The findings from a kidney biopsy give important clues about the disease. Doctors use the Oxford classification system to describe five aspects of kidney disease, also known as MEST-C score. These factors include:

• Mesangial hypercellularity — Too many cells in the kidney
• Endocapillary hypercellularity — Too many cells in the blood vessels
• Segmental glomerulosclerosis — Scarring in the kidney
• Tubular atrophy/interstitial fibrosis — Damage to the kidney’s tubules (tiny tubes) and interstitium (surrounding tissue)
• Crescents in the glomerulus – Abnormal cells surrounding the glomerulus (filtering unit)

IgA antibody complexes are deposited in the glomerulus, so damage usually starts in the glomerular area and its blood vessels. Other parts of the kidneys become involved later.

High blood pressure is both a cause and a consequence of kidney disease.

In IgA nephropathy, proteinuria and damage caused by the immune system can extend to the tubules and interstitium, leading to inflammation and scarring. Tubulointerstitial damage is a strong indicator of chronic kidney disease and is associated with a worse prognosis. When there’s fibrosis (a lot of scarring), the kidneys struggle to function properly.

Depending on your MEST-C score, doctors can predict the progression of the kidney damage and may tailor treatment plans more precisely.

5. Age and Sex

Your age and sex can influence how IgA nephropathy progresses. Generally, older age at diagnosis can be associated with a worse prognosis. Sex also plays a role, with men often showing a more aggressive form of the disease, according to Mayo Clinic.

Understanding how age and sex affect the disease helps in predicting outcomes and tailoring treatment plans. For example, older people might need more aggressive treatment or closer monitoring.

6. Lifestyle Factors for Managing IgA Nephropathy

Your lifestyle can also affect outcomes with IgA nephropathy. For example, eating a healthy diet and getting stress under control may influence your prognosis.

Diet and Nutrition

A balanced diet of vegetables, fruits, lean protein, and whole grains supports overall health and can help manage symptoms of IgA nephropathy. Some studies suggest that a plant-based diet can be beneficial for kidney health.

Although protein is essential for health, eating too much of this nutrient can put extra strain on the kidneys. Work with a registered dietitian to find the right balance for your needs.

Limiting salt intake helps control blood pressure, which is key for slowing kidney damage. Aim for less than 2,300 milligrams of sodium per day. Your nephrologist may have more specific advice on sodium intake for you to follow.

Stress Management

Managing stress is important for kidney function and overall health. Techniques such as meditation, deep breathing exercises, and yoga can help reduce stress and improve your well-being.

How To Improve Your Outcome With IgA Nephropathy

Every person living with IgA nephropathy is different. Keep in touch with your kidney specialist, attend all recommended appointments, and work with your doctor to find an effective treatment plan that works for you. Making certain lifestyle changes and talking to your doctor about medication options may help you maintain kidney function and improve your outcome with IgA nephropathy.

Lifestyle Changes

Below are some additional lifestyle factors that can affect IgA nephropathy. Adopting some healthy habits may improve your outcome.

• Drinking too much alcohol can raise blood pressure and harm the kidneys. Stick to moderate drinking guidelines: up to one drink per day for women and two max for men, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
• Smoking can damage blood vessels, reduce blood flow to the kidneys, and worsen kidney disease. One of the best things you can do for your kidneys and overall health is to quit smoking.
• Engaging in regular physical activity helps control blood pressure, manage weight, and improve overall health. Aim for around 30 minutes of moderate-intensity exercise per day, such as brisk walking or cycling.

Treatment Options

Iptacopan (Fabhalta) was approved by the U.S. Food and Drug Administration (FDA) in 2024 to reduce proteinuria in adults with IgA nephropathy. Other medications may also be used to manage IgA nephropathy. These drugs include:

• ACE inhibitors — Benazepril (Lotensin), captopril, enalapril (Vasotec), lisinopril (Prinivil)
• Angiotensin-receptor blockers — Azilsartan (Edarbi), candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar)
• Statins to lower cholesterol
• Immunosuppressants such as corticosteroids

In case of kidney failure, you may need dialysis or a kidney transplant. Further research is underway to find new treatments that work in different ways to improve outcomes.

Keep in Touch With Your Doctor

Regular follow-ups with your nephrology specialist are essential for monitoring renal function, adjusting treatments, and catching any new or worsening issues. Follow your nephrologist’s recommendations for lab tests and other monitoring, and be sure to ask them any questions you have about living with IgA nephropathy.

Talk With Others Who Understand

At MyKidneyDiseaseCenter, the site for people with kidney disease and their loved ones, people come together to gain a new understanding of kidney disease and share their stories with others who understand life with kidney disease.

Are you living with IgA nephropathy? What lifestyle changes have you made to improve your prognosis? Post your experience in the comments.