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.
