IgA Nephropathy - Causes, Symptoms, Diagnosis, and Management

Introduction

IgA Nephropathy, known as Berger’s disease, occurs as a result of the deposition of IgA antibodies in the kidneys. IgA is nothing but an antibody synthesized by the immune system in response to foreign agents. The deposited antibody will cause inflammation of the kidneys, which eventually results in the reduction of kidney function. It is a slowly progressive disease with a varied clinical course in different persons. There is no specific treatment for IgA nephropathy, but the treatments are aimed at improving kidney function and managing the associated symptoms.

What Is IgA Nephropathy?

IgA Nephropathy is a condition where the glomeruli of the kidneys are accumulated by the IgA antibodies. This, in turn, reduces the filtration capacity of the kidneys by causing inflammation of the kidneys and progressing to further complications.

What Are Glomeruli?

Glomeruli are the tiny loop of blood vessels in the kidneys which filters and removes extra fluid from the blood. When the glomeruli are damaged, the filtering capacity of the kidneys is altered, leading to renal diseases, which further progresses to end-stage renal disease(renal failure).

What Is the Epidemiology Of IgA Nephropathy?

It is more common in men than in women. It can occur at any age but is most frequently reported around 30 years of age. It is reported to be high in Asian and Caucasian populations and is found to be one of the most common kidney diseases.

What Is the Etiology Of IgA Nephropathy?

There is no specific evidenced cause for this condition; researchers believe that these could be the possible reasons for the disease.

• Autoimmunity - Few studies report that IgA nephropathy is an autoimmune disorder where the body cells secrete antibodies against the glomeruli of the kidneys.

• Genetic Role - Few researchers stated that it has a genetic link, where it runs in families and certain ethnic groups.

• Infections - These could be caused due to the body's immune response to certain bacterial and viral infections.

• Others - Few studies show that it could be initiated due to other associated conditions such as liver cirrhosis (In which normal liver tissue is replaced by scar tissue) and celiac disease ( a digestive condition in which the small intestine is hypersensitive to gluten) etc.,

What Are the Signs and Symptoms Of IgA Nephropathy?

The disease may go unnoticed for years since it does not show any symptoms in the early stages. Symptoms usually occur as the disease progresses, which include:

• Hematuria - It is characterized by the appearance of blood in urine, the first and foremost symptom to appear. Due to the presence of red blood cells, the urine appears to be cola or tea-colored. This indicates that the glomeruli are damaged.

• Proteinuria - Presence of protein in the urine, mainly albumin (albuminuria). The urine appears foamy due to the presence of a protein that leaks from the blood in the urine.

• Edema - Swelling of hands and foot due to the presence of excess fluid in the interstitial spaces.

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• Pain - Localized over the back region below the ribs due to inflammation and damage to the kidneys.

• High Blood Pressure - Due to diminished kidney function.

As the disease progresses, the following symptoms will be seen.

• Oliguria - Decreased urination.

• Drowsiness.

• Generalized edema.

• Generalized itching.

• Headaches.

Weight loss.

• Loss of appetite.

• Nausea and vomiting.

• Sleeplessness.

• Darkening of skin.

• Drowsiness.

How to Diagnose IgA Nephropathy?

The diagnosis of IgA Nephropathy will be made by three factors:

1. History

A proper and thorough history of the symptoms and the family history to understand if any genetic link in families should be carried out by the physician. This serves as a key to the final diagnosis of this condition.

2. Physical Examination

• Examination of the Patient - To check for edema in the body parts, especially the hands and the foot.

• Monitoring Blood Pressure - Blood pressure should be checked and monitored frequently.

• Others - Medical history, family history, and edema provide a clue in the diagnosis of kidney disease.

3. Laboratory Investigation

• Blood Test - The blood test is aimed at measuring the estimated glomerular filtration rate of the kidneys. It is done to find out the filtration rate of the kidney and to understand the functioning ability of the kidney.

The values of eGFR indicate the stage of the disease

Values of eGFR of 60 and above - represent normal kidney function.Values of eGFR below 60 and above 15 - represent progressing kidney disease.Values of eGFR of 15 and below - represent end-stage kidney disease.

• Urine Test:

Urine Albumin to Creatinine Ratio (UACR)

• This ratio tells us the amount of albumin excreted in the urine in proportion to creatinine. The value of more than 30 milligrams of albumin per gram of creatinine is seen in patients with chronic kidney disease.

To Check for Protein and Blood in the Urine

• To analyze the presence of protein and blood in urine, a chemical test called the “Dipstick test” is performed. The urine sample is collected, and the drops of urine are placed over the strips in the test kit. The change in color of the strip confirms the presence of protein and blood in the urine.

• Kidney Biopsy

• A special type of needle is used to remove a small amount of tissue from the kidney to check for IgA antibodies against the glomerular tissue through microscopic analysis. This serves to be the confirmatory diagnosis of IgA Nephropathy.

How to Manage IgA Nephropathy?

There is no accurate cure for this condition; the management protocol involves the steps to delay further progression of the disease and relieve the symptoms,

Steps in management include:

1. To Treat Edema

Edema is due to the accumulation of extra fluid in the interstitial spaces, which are not excreted by the kidneys. These fluids can be removed from the body with the help of Diuretics, which helps to remove the excess fluid and thereby reduce edema and hypertension.

2. To Treat Hypertension

Antihypertensive medications such as Angiotensin-Converting Enzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARB) are found to be effective in lowering blood pressure as well as slowing down the progression of kidney disease. Patients with uncontrolled hypertension can be prescribed combination drugs such as beta-blockers and calcium channel inhibitors along with ACE inhibitors and ARBs.

3. To Reduce Blood Cholesterol Levels

Anti-cholesterol medications such as Statins can be prescribed to reduce the high cholesterol levels in the blood.

4. To Suppress the Hyperactivity of the Immune System

The drugs such as Corticosteroids and Cyclophosphamides can be prescribed to reduce inflammation and suppress the hyperactive immune system. Omega -3 fatty acid supplements are also found to be effective in reducing the activity of IgA.

What Are the Complications Of IgA Nephropathy?

The complications of IgA Nephropathy include

• High cholesterol levels.

• High blood pressure.

• Acute and Chronic kidney disease.

• Nephrotic syndrome.

What Are the Ways to Prevent the Complications Of IgA Nephropathy?

Patients with diagnosed IgA Nephropathy or with a family history of it can prevent the complications by following proper eating habits. They are usually advised,

• To reduce the amount of salt and protein they take.

• To have a check on the amount of water intake.

• Eating low-fat food.

• Monitoring their blood pressure levels frequently.

• To take Omega 3 fatty acid supplements.

Conclusion

IgA Nephropathy is a slowly progressing disease. There is no specific treatment for this condition; keeping the blood pressure under control and reducing serum cholesterol levels will slow down the disease's progress. The main goal is aimed to stop the disease from progressing into end-stage renal disease. Proper knowledge about the disease symptoms will help seek medical help at the earliest.