IgA nephropathy

Overview

IgA nephropathy is a kidney disease where a protein called IgA builds up in the tiny filters of your kidneys, causing inflammation and damage over time. It can gradually reduce the kidneys' ability to filter waste from the blood.

IgA nephropathy is considered a rare disease, but it is still one of the more common forms of kidney inflammation worldwide. It is more often found in East Asian and Caucasian populations.

It can affect people of any age, but it most often starts in teenagers and young adults up to their late 30s. It is about twice as common in men as in women.

Symptoms

Common symptoms

• Blood in the urine (may look dark, rusty, or cola-colored)
• Foamy or bubbly urine (a sign of protein leaking)
• Swelling in the hands, feet, ankles, or around the eyes (fluid retention)
• High blood pressure that is hard to control

Symptoms in children

• Blood in the urine, often noticed after a cold or stomach infection
• Swelling around the eyes, especially in the morning
• Dark or reddish urine that may come and go

Symptoms in older adults

• High blood pressure that is difficult to manage
• Swelling in the legs or ankles
• Fatigue and feeling generally unwell

Causes

Main causes

• The exact cause is unknown, but it involves the immune system making an abnormal form of IgA that gets stuck in the kidney filters.
• It may be triggered by common infections like colds, flu, or stomach bugs.
• Genetics can play a role – it sometimes runs in families.

Risk factors

• Being male
• Having a family history of IgA nephropathy or other kidney diseases
• Being of East Asian or Caucasian descent

When to see a doctor

See a doctor urgently if:

• Any episode of visible blood in your urine
• New or worsening swelling in your body
• High blood pressure that is not controlled with your current treatment
• Foamy urine that does not go away

Book a routine appointment if:

• If you have a family history of kidney disease and want to check your kidney health
• If you notice occasional dark urine or mild swelling
• If a routine urine test showed blood or protein

Diagnosis

A doctor will use urine and blood tests to look for signs of kidney damage. The only way to confirm IgA nephropathy is with a kidney biopsy – a small sample of kidney tissue is examined under a microscope.

Tests that may be done

• Urine test (to check for blood and protein)
• Blood test (to measure kidney function, creatinine, and other markers)
• Blood pressure check
• Kidney biopsy – a needle is used to take a tiny piece of kidney tissue
• Ultrasound of the kidneys to see their size and shape

What to expect at your appointment

The process can take a few weeks. You will see a kidney specialist. A biopsy is done at a hospital with local anaesthetic to numb the area. You may need to stay for a few hours for observation. It is a safe procedure, but can be uncomfortable.

Treatment

Treatment depends on how much kidney damage there is. The goal is to control symptoms, slow the disease, and prevent complications. Some people with very mild disease may not need any treatment.

Self-care at home

• Check your blood pressure regularly at home and keep a log
• Drink enough fluids, but follow your doctor's advice if you have fluid restrictions
• Take all prescribed medications exactly as directed
• Avoid smoking and limit alcohol
• Exercise regularly and maintain a healthy weight

Medical treatments

Doctors may prescribe medications to lower blood pressure and reduce protein in the urine. If inflammation is severe, they may recommend medicines that calm the immune system. Some people need diuretics (water pills) to reduce swelling. In advanced cases, treatments to remove waste products from the blood may be started. You will have regular follow-ups to adjust the plan.

When is surgery considered?

If the kidneys fail completely, you may need dialysis (a machine to filter blood) or a kidney transplant. This is only for end-stage kidney disease, which many people never reach.

Living with this condition

Many people with IgA nephropathy live active, normal lives. You will need regular check-ups with your doctor, usually every few months. Keep track of symptoms, blood pressure, and any changes in how you feel.

Lifestyle tips

• Stay active – walking, swimming, or gentle exercise is good
• Manage stress with relaxation techniques or hobbies
• Avoid over-the-counter painkillers like ibuprofen and naproxen unless your doctor says they are safe
• Keep a symptom diary to discuss at appointments

Diet and exercise

A balanced diet is important. You may need to limit salt, protein, and foods high in potassium or phosphorus if your kidney function is reduced. A dietitian can help. Regular exercise helps control blood pressure – aim for at least 30 minutes of moderate activity most days.

Mental health and emotional wellbeing

Living with a chronic condition can cause worry, stress, or sadness. It is normal to feel this way. Please talk to your doctor or a counsellor. If you ever feel overwhelmed, reach out for crisis support. You do not have to face this alone.

Prevention

There is no known way to prevent IgA nephropathy. However, early detection and good management can slow the progression and prevent complications.

Vaccines

Your doctor may recommend flu and pneumonia vaccines to reduce the risk of infections that can trigger symptoms.

Screening programmes

If you have a family history, regular urine tests can help detect blood or protein early. Talk to your doctor about how often you should be checked.

Complications

If left untreated

• Chronic kidney disease – kidney function gets worse over time
• High blood pressure that can further damage the kidneys
• End-stage kidney disease – when kidneys can no longer clean the blood
• Fluid buildup, anemia, bone disease, and heart problems

Long-term outlook

With proper care, many people with IgA nephropathy maintain good kidney function for decades. Some people's disease stays very mild and never causes serious problems. If kidney function does decline, treatments like dialysis and transplant are very effective. Your outlook is personal – your doctor can give you a better idea based on your specific situation.

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