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Answer to your Health Question

Question:

I have been diagnosed with IgA nephropathy or Berger's disease.

I would like to know if there are physical limitations and what is going on with my kidneys and my overall health.

Thanks

Charles

Answer:

Dear Charles,

In IgA nephropathy there is a slow progression to chronic renal failure in 25-30% of cases during a period of 20 years.

IgA nephropathy, which was initially thought to be a benign disease, has been shown to have not-so-benign long term outcomes

Complete remission, i.e. a normal urinalysis, occurs rarely in adults, in about 5% of cases. Thus, even in those with normal renal function after a decade or two, urinary abnormalities persist in the great majority.

Overall, though the renal survival is 80 - 90% after 10 years, at least 25% and may be up to 45% of adult patients will eventually develop end stage renal disease.

It's clear that IgAN is not simply a kidney disease but rather an immunological disorder that affects the kidneys,

It may also be a disease, like diabetes, that affects the micro blood vessels. If true, this would explain some common extra-renal symptoms, such as headaches, temporary vision problems, and difficulties concentrating.

A study from Mayo Clinic did show that long term treatment with omega-3 fatty acids results in reduction of progression to renal failure, without, however, reducing proteinuria in a subset of patients with high risk of worsening kidney function.

However, these results have not been reproduced by other study groups and in two subsequent meta-analyses.

Fish oil therapy does not have the drawbacks of immunosuppressive therapy. Also, apart from its unpleasant taste and abdominal discomfort, it is relatively safe to consume.

The events that tend to progressive renal failure are not unique to IgA nephropathy and non-specific measures to reduce the same would be equally useful. These include low-protein diet and optimal control of blood pressure.

The choice of the antihypertensive agent is open as long as the blood pressure is controlled to desired level. However, Angiotensin converting enzyme inhibitors and Angiotensin II receptor antagonists are favoured due to their anti-proteinuric effect.

The course of IgA nephropathy varies considerably from person to person. Some people have the disease for years with few problems; many cases, in fact, may go undiagnosed. Other people develop one or more of the following complications:

==High blood pressure. Damage to your kidneys from IgA deposits can raise your blood pressure.

==Acute kidney failure. If your kidneys lose their filtering ability due to IgA deposits, waste products build up quickly in your blood. When this happens, you may need to undergo temporary hemodialysis - an artificial way of cleansing your blood when your kidneys aren't able to do so. During hemodialysis, a needle is inserted into your arm through a special access point. Your blood is then directed through the needle and tubing to a machine called a dialyzer, which filters your blood a few ounces at a time. The filtered blood returns to your body, through another needle.

==Chronic kidney failure. IgA nephropathy can cause your kidneys to gradually stop functioning. Kidney function at less than 10 to 15 percent of normal capacity is considered end-stage kidney disease. In such cases, permanent dialysis or a kidney transplant is needed to sustain life.

==Nephrotic syndrome. This is a group of problems that can be caused by damage to the glomeruli, including high urine protein levels, low blood protein levels (hypoalbuminemia), high cholesterol and swelling of your eyelids, feet and abdomen.

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