Do you also have blood in your urine? Let's talk about IgA Nephropathy!

Have you ever noticed a little blood in your urine? Or do you have swollen legs, a feeling of weakness, or constant fatigue? These could be signs of kidney disease, my friend. Today we are going to talk about a kidney disease that has a somewhat complicated name, but one that we all need to be aware of. It is IgA Nephropathy. Don't worry, let's talk about it simply.

What is IgA Nephropathy? Simply put...

Simply put, IgA nephropathy is a type of kidney disease. What happens in this is that an `(Antibody)` in our body, that is, an antibody called `IgA`, accumulates inside the kidneys, causing inflammation, that is, swelling. This inflammation damages the very small blood vessels in the kidneys, the parts called `(Glomeruli)` that work like filters. Imagine, our kidneys are like two filters that filter the waste products in the body and release them as urine. So, when these `(Glomeruli)` are damaged, blood (`(Hematuria)`) and protein (`(Proteinuria)`) start coming out of the kidneys with the urine.

It is also known by other names, such as `IgAN` and `Berger's disease`. The reason for this is that two French doctors, Jean Berger and Nicole Hinglas, first discovered this disease in the late 1960s.

What does this name mean?

The name "IgA nephropathy" sounds a bit long, doesn't it? Let's see what it means.

• Immunoglobulin A (IgA): This is the antibody I mentioned earlier. It is a protein made by our immune system, the system that protects us from disease. Its main function is to protect us from foreign invaders like bacteria and viruses.
• Nephropathy: This is a medical term. Simply put, it is used to describe any damage, disease, or other problem that occurs to the kidneys.

Is this life threatening?

Here's the important thing. If left untreated, IgA nephropathy can gradually worsen and lead to kidney failure. Kidney failure can be life-threatening if left untreated. But don't worry, with proper treatment, the course of this disease can be largely controlled.

How common is this disease?

IgA nephropathy is actually a very common kidney disease. It can affect people of any age. Its prevalence varies in different parts of the world. It is reported that this disease is seen more frequently in East Asian countries, that is, in the region where we live. This condition is also something that doctors often see in Sri Lanka.

What are the main symptoms?

Often, there may be no symptoms at first. The disease can persist for years or even decades without any signs. However, when symptoms do appear, you may notice things like:

• Blood in the urine: Sometimes the urine can turn red, brown, or the color of tea water. This is the first symptom that many people notice.
• Flank pain: This refers to pain on either side of the waist, where the kidneys are located.
• Swelling (Edema): Swelling can occur, especially in the legs, ankles, abdomen, and sometimes the face.
• Foamy urine: If you see more foam in your urine than usual, that is also a sign.

Imagine, Samantha (a fictitious name) is a young teacher. One day, after she got better with a fever, she noticed that her urine was turning red. She didn't pay attention to it at first, thinking, "Maybe it's just fatigue." But after a few days, her legs started to swell, and she felt very tired. It was only after seeing a doctor and getting tests that she was diagnosed with IgA nephropathy.

Why does this disease occur? What are the causes?

Medical experts believe that IgA nephropathy is an ``autoimmune disease.`` Simply put, what happens here is that our own immune system, the soldiers that are supposed to protect us from disease, mistakenly attacks our own kidneys.

People with IgA nephropathy have less of a type of sugar called `(Galactose)` in their `IgA` antibodies than normal. Our immune system recognizes this `(Galactose)`-deficient `IgA` as a "foreign invader". Then this happens:

• Other antibodies in our body bind to this `(Galactose)`-deficient `IgA`.
• This `IgA` combines to form small clumps called `Immune complexes`.
• These `(Immune complexes)` get stuck in the little filters in our kidneys, called `(Glomeruli)`.
• Then inflammation occurs there and the kidneys begin to be damaged.

When we have a cold, flu, or sore throat, these `IgA immune complexes` circulate in our bodies in greater amounts. Some of these end up in the kidneys, so some people only start to develop symptoms of IgA nephropathy after they have had a cold or flu.

Is this something that comes from generations?

For some people, this may be related to a family history of the disease. That is, there may be a genetic influence that runs in families. Doctors have found some genetic markers. That is, there may be a link between certain gene mutations and IgA nephropathy.

Who is most affected by this disease?

Although anyone can develop IgA nephropathy, some people are at higher risk. These include:

• If someone in the family has IgA nephropathy.
• If someone in your family has `IgA vasculitis` (also called `(Henoch-Schönlein purpura)`).
• American surveys show that men are twice as likely to be at risk than women.
• For young people between the ages of 15-18 and their late 30s .
• People of Asian or European descent. It is said that people in Asian countries like Sri Lanka may see this a little more.

At what age does this usually start?

Although this disease can affect people of any age, the first symptoms often begin to appear in a person's youth, between the ages of 15-18 and the late 30s.

What complications can occur if left untreated?

If IgA nephropathy is not treated properly, various complications can develop over time. The main ones are:

• Hypertension: This means increased blood pressure .
• Acute kidney failure: Sudden loss of kidney function.
• Chronic kidney failure: The gradual weakening of the kidneys over time .
• Nephrotic syndrome: This is a condition in which the kidneys excrete large amounts of protein in the urine. This causes swelling and high cholesterol levels.
• Cardiovascular system problems: This means that the risk of developing heart disease and blood vessel problems increases.

How do doctors accurately diagnose this disease?

When you see a doctor, he or she will ask you about your symptoms, whether anyone in your family has had this condition, and your medical history. Then they will do a physical exam, which may include checking your blood pressure and checking for swelling. In addition, they may do the following tests:

• Urinalysis: Checks for blood and protein in the urine.
• Blood tests: Check the levels of cholesterol, protein, and waste in the blood.
• Estimated glomerular filtration rate (eGFR) blood test: This measures how much blood your kidneys are effectively filtering per minute.
• Urine protein test: Checks for protein and/or a type of protein called albumin in the urine.
• 24-hour urine collection tests: Collect urine throughout the day and see how much protein is excreted.

Is a kidney biopsy necessary?

Yes, if other tests raise suspicion about this disease, the most important test to confirm the disease is a kidney biopsy . In this, a doctor takes a very small piece of tissue from the kidney using a small needle-like instrument. Then a pathologist, a specialist in tissue examination, looks at that piece under a microscope. Then, it can be said exactly whether IgA is deposited in the kidneys, how much damage has occurred, and what stage of the disease is.

What are the treatments available?

The main goal of treatment is to control the progression of the disease and prevent it from progressing to end-stage renal disease (ESRD). If a doctor tells you that you have IgA nephropathy, they will likely refer you to a nephrologist, a doctor who specializes in kidney disease.

Treatments for IgA nephropathy may include the following medications:

• Control blood pressure: Medications like `(Angiotensin-converting enzyme - ACE) inhibitors` and `(Angiotensin receptor blockers - ARBs)`. These lower blood pressure and also reduce damage to the kidneys.
• Remove excess water from the body: Diuretic medications, commonly known as "water pills."
• Control the immune system: To reduce inflammation in the kidneys, other medications such as steroids (e.g., prednisone) or cyclophosphamide may be given. These are given depending on the severity of the disease.
• Lower cholesterol levels: Medications like `(Statins)`.

Does removing the tonsils (Tonsillectomy) help with this?

Some research has shown that a small number of people with IgA nephropathy may benefit from tonsillectomy. However, this is not a treatment for everyone . It is best to talk to your doctor to see if this is right for you.

What should you expect when living with this disease?

This can vary from person to person. Sometimes IgA nephropathy gets better with simple treatments. Rarely, the disease can rapidly worsen, leading to kidney failure within a few years.

However, with the right treatment, most people can live with their kidneys as healthy as possible and control the progression of the disease.

According to studies, about one in four adults with IgA nephropathy are at risk of developing kidney failure over time. Among children, this risk may be as high as one in 10 to 20.

Will a kidney transplant be necessary?

It also varies from patient to patient. Not everyone's disease progresses at the same rate. Some people respond well to treatment and can live with the condition for a long time.

If your kidneys suddenly stop working completely due to IgA nephropathy, you may need to consider dialysis (a blood-cleansing procedure) or a kidney transplant. Your medical team will discuss all of these options with you.

How long does this disease last?

IgA nephropathy is a progressive kidney disease that usually lasts a lifetime. This means that it may get worse over time. However, medication can slow down the rate of progression.

What about lifespan?

Studies have shown that the average life expectancy of people with IgA nephropathy can be reduced by about 6 to 10 years compared to someone without the disease. However, this is just a statistic. Don't forget that with good treatment and lifestyle changes, this condition can be largely controlled.

Can I live a normal life?

Absolutely yes! If treated properly and lived as their doctor recommends, most people with IgA nephropathy can live long, happy lives. They can continue to work, go to school, and do the things they love.

Is there a way to prevent this from happening?

Unfortunately, there is no proven way to prevent IgA nephropathy. However, if someone in your family has the disease, it is important to talk to your doctor about ways to stay healthy, especially to keep your blood pressure and cholesterol levels under control.

Does food and drink have an effect on this?

Research has not yet found a direct link between eating habits or nutrition and preventing the development of IgA nephropathy.

What foods and drinks should be avoided?

A doctor may tell a person with IgA nephropathy to limit certain foods and drinks, including:

• Reducing salt .
• Limiting protein- rich foods (like meat, fish, eggs, and milk).

If you have high cholesterol levels, you may be advised to reduce saturated fat and foods high in cholesterol.

Why do you say to reduce protein?

Some of the substances produced when protein is digested need to be filtered out by the kidneys. So, if you eat too many protein-rich foods, your kidneys have to work harder, which can make your kidneys weaker faster. However, if you don't eat enough protein, you can develop problems like malnutrition. So, it's best to see a renal dietitian to help you create a diet that's right for you and that's good for your kidneys. If you've been advised to reduce your protein intake, you may need to have regular blood tests to check your protein levels.

Should I take Omega-3 pills?

For some people with IgA nephropathy, doctors may recommend fish oil supplements containing omega-3 fatty acids. Some studies show that these may lower blood pressure and slow the progression of the disease.

However, it is very important to never start taking any supplement, even fish oil pills, without consulting a doctor.

When should I see a doctor?

To stay healthy, it's a good idea to see a doctor regularly and get regular checkups , just like everyone else. Early detection can help prevent IgA nephropathy from progressing to kidney failure. Also, if you have other conditions that can affect your kidneys, such as high blood pressure or diabetes, it's important to work with your doctor to manage them properly.

When should you go to an Emergency Treatment Unit (ETU) ?

If you have IgA nephropathy and develop symptoms of kidney failure, you should go to the nearest emergency room immediately. Such symptoms include:

• Feeling more tired than usual is ``Fatigue''.
• The frequency or amount of urination increases or decreases more than expected.
• The food is tasteless.
• Insomnia or difficulty concentrating.

What are the important questions to ask the doctor?

When you learn about this disease, you may have many questions. It is important to ask your doctor and have them clarified. Here are some questions you can ask:

• How do you accurately diagnose IgA nephropathy?
• What is the best treatment for me?
• What are the side effects of the treatments you recommend?
• Will having my tonsils removed help me?
• Should I see a renal dietitian?
• Is it a good idea for me to take fish oil supplements?
• How often should I have blood and urine tests?
• Will I need a kidney transplant?
• Are there any clinical trials that might be suitable for me?
• Can you tell me about support groups for people with IgA nephropathy?

Finding out you have kidney disease can be a big shock. There's a lot of information coming to mind at once, tests to be done, appointments to see specialists... It's normal to feel overwhelmed with all of that. The most important thing is to take a breath and really understand what IgA nephropathy is.

For some people, this is not so serious, and simple treatments and regular tests can help maintain kidney function. For others, medication is needed to protect the kidneys. But remember, this disease is manageable, and with proper treatment, you can live well for many years.

Get help from your family and friends. Support groups for people with similar illnesses can also be a good place to share your thoughts. Don't hesitate to ask a doctor if you have any questions, my friend.

Final Take-Home Message

Okay, so we've talked a lot about IgA nephropathy, haven't we? Finally, here are the most important things you need to remember:

• Early detection is very important: therefore, if you have symptoms such as blood in the urine or swelling, be sure to see a doctor.
• Follow the treatment instructions carefully: Take the medicine prescribed by the doctor on time. Follow the instructions.
• Lifestyle changes: Follow your doctor's advice about diet and exercise. If they tell you to control your salt and protein intake, do so.
• Regular medical checkups: Get regular checkups as directed by your doctor and keep an eye on the condition of your kidneys.
• This is a manageable disease: Don't worry. With proper treatment and a healthy lifestyle, you can live a happy and healthy life with IgA nephropathy.
• You are not alone: ​​you have family, friends, and doctors to help you. You can also find great strength in support groups.

Take care of your kidney health, friend!

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