Supportive Care for IgA Nephropathy: Why It’s Essential

Posted on July 5, 2023

  • There’s no cure for immunoglobulin A (IgA) nephropathy, but it’s possible to influence the disease progression with your health care decisions.
  • Most people with IgA nephropathy need to proactively control their blood pressure, even if they don’t have hypertension (high blood pressure).
  • Supportive care for IgA nephropathy may include medication, monitoring, and lifestyle changes, especially restricting sodium.

IgA nephropathy, or Berger’s disease, happens when inflammation builds up in the kidneys and impairs kidney function. There’s no specific cure, making supportive care — focusing on reducing symptoms — essential for protecting your kidneys and improving your quality of life with IgA nephropathy.

The condition tends to occur in young people, and life with IgA nephropathy changes with time. Some people enter remission, when their symptoms ease up or disappear, while others progress to end-stage renal disease and dialysis. Monitoring your symptoms, taking medication, and making lifestyle changes can help slow disease progression. Here’s how supportive care works for IgA nephropathy.

Manage Blood Pressure

Supportive care involves treating the related signs and symptoms of IgA nephropathy, including factors that can affect the disease course. For instance, hypertension puts extra strain on the kidneys, so people with IgA nephropathy need to be mindful of blood pressure management and heart health. Supportive care for IgA nephropathy may include monitoring blood pressure at home, taking medication to address high blood pressure, or changing your lifestyle to support a healthier heart.

Studies suggest that people with IgA nephropathy begin to have blood pressure spikes in the early stages of the disease. Even relatively normal blood pressure can rise slightly, affecting the heart and kidneys. For this reason, health experts recommend antihypertensive medication for people with IgA nephropathy — specifically, angiotensin-receptor blockers or ACE inhibitors.

You may need a combination of other blood pressure meds, including calcium channel blockers and beta-blockers. In addition, removing extra fluid from the body with diuretics can make other hypertension medications more effective in keeping your blood pressure down.

Monitor Protein in the Urine

Proteinuria (protein in the urine) is a common sign of IgA nephropathy. This condition is also called albuminuria because albumin is a form of protein in the blood that can leak into the urine, making urine look foamy.

When your albumin levels are low, your blood is less effective at drawing out extra fluid from the rest of your body. As a result, your lower extremities, like your feet and ankles, may swell up.

Your doctor can use blood and urine tests to check for albumin. For example, a urine test called the urine albumin-to-creatinine ratio (UACR) measures how much albumin was excreted in the past 24 hours.

A type of medication called sodium-glucose cotransporter-2 (SGLT2) inhibitors can be beneficial for chronic kidney disease. SGLT2 inhibitors were developed to help lower blood sugar levels in diabetes, but in clinical trials, researchers uncovered the benefits of these drugs for people who have kidney disease, heart failure, and persistent proteinuria.

Examples of SGLT2 inhibitors that can help protect renal function include:

  • Bexagliflozin (Brenzavvy)
  • Canagliflozin (Invokana)
  • Dapagliflozin (Farxiga)
  • Empagliflozin (Jardiance)
  • Ertugliflozin (Steglatro)

If your UACR remains high, your doctor might suggest you take Filspari, a formulation of sparsentan approved by the U.S. Food and Drug Administration (FDA) in early 2023 for treating people at high risk of kidney disease progression.

Your health care team can help determine if and what medication you should start as part of supportive therapy.

Consider Additional Medications

Depending on your health and risk factors, your doctor may recommend other medications as part of supportive care for IgA nephropathy. They may also encourage you to take statin medications if you have high cholesterol levels.

In addition, your health care provider may prescribe medication to help control your immune system and reduce inflammation. Examples include corticosteroids, like prednisone, and immunosuppressive treatment with cyclophosphamide (Cytoxan).

Although some research suggests that immunosuppression shouldn’t be a first line of treatment, this approach may have more beneficial effects for certain subgroups, such as children at high risk of rapid disease progression.

It’s important to follow up with your doctor if you experience any side effects or adverse events related to your IgA treatment plan. Finding the right mix of supportive care options can take some trial and error based on your body’s response to different therapies.

Make Healthy Lifestyle Choices

You can’t prevent or cure IgA nephropathy with lifestyle changes. However, healthy choices can help maintain your glomerular filtration rate, a test for kidney health that looks at how much blood is filtered through your kidneys every minute.

If you have IgA nephropathy, it’s essential to quit smoking and keep active to ward off disease and maintain a healthy weight. Ask your doctor for resources or a referral if you need support to reach these goals. A mental health professional or personal trainer can give you the tools you need to improve your supportive care measures.

Eat Right for Your Kidneys

Changing your diet to restrict sodium and saturated fat is good for your kidneys and your heart. Statistics show that cutting down on salt may lower your risk of heart attack and stroke by 20 percent. Low-sodium diets also keep your kidneys from having to work too hard.

High-sodium foods include:

  • Canned soups and vegetables
  • Condiments, including salad dressing
  • Frozen dinners
  • Processed meats (like bacon, hot dogs, and cold cuts)
  • Salty snacks like pretzels and chips

Even if you don’t use the saltshaker, you could get a lot of unwanted salt from eating processed foods that are high in sodium — some might not even taste salty. That’s why it’s crucial to learn how to read food labels and spot sources of sodium. Look for versions of your favorite products that say “no added salt,” “unsalted,” or “low sodium” on the label. Add plenty of fresh fruits and vegetables to your grocery list — eating fresh produce will help you naturally fill up with less salt.

In general, restaurant meals are high in sodium. Both fast-food restaurants and fine dining establishments use extra salt to preserve food and enhance flavor. Try cooking from home more often and, when possible, requesting that restaurant meals be prepared without salt.

It’s smart to avoid high-protein diets when living with IgA nephropathy. Eating more protein than your body needs can ramp up kidney dysfunction. Cut back on high-fat meat and dairy products to limit your intake of sodium, saturated fat, and protein. Instead, focus on high-fiber alternatives, like beans, nuts, and whole grains.

Making changes such as these can help reduce swelling and prevent cardiovascular problems like strokes and heart attacks. Your doctor may also suggest using a fish oil supplement to reap the beneficial effects of omega-3 fatty acids on inflammation and kidney health.

A registered dietitian nutritionist can provide supportive care and guidance for eating well with IgA nephropathy. Regular follow-up visits for monitoring your nutrient levels will help you stay on track and get support if your dietary needs change with the progression of 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.

What types of supportive care interventions have you used to reduce IgA nephropathy disease progression? Have you tried hypertension medication, diet changes, or immunosuppressive therapy? Post your experience in the comments.

    Posted on July 5, 2023
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    How Has IgA Nephropathy Affected Your Daily Life And Quality Of Life Over Time?
    August 1, 2023 by MyKidneyDiseaseCenter
    Sarika Chaudhari, M.D., Ph.D. completed her medical school and residency training in clinical physiology at Government Medical College, Nagpur, India. Learn more about her here
    Anastasia Climan, RDN, CDN is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here

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