IgAN is the world’s most common glomerulonephritis

In IgA Nephropathy

In IgA Nephropathy [IgAN], unknown agents cause the glomeruli to become — and to stay — inflamed. IgAN is the world’s most common glomerulonephritis [inflammation of the glomeruli], but its pathogenesis [how the disease develops] is not known. IgAN is considered to be an immune-complex mediated disorder (or immunologically mediated disorder), which means that immune complexes may not be the direct cause of the disease but they help bring about the end result, which is widespread inflammation of the kidneys.

Immune complexes form when the body is exposed to an antigen, such as a virus, bacteria, toxin, or even allergen. In response, your body sends out antibodies, which are immunoglobulins produced by a certain class of white blood cells known as B-cells. There are five main classes of these immunoglobulins, with IgA [immunoglobulin A] being the main one directed against bacterial and viral antigens.

Antibodies lock onto the surfaces of viruses and other foreign cells, producing antigen-antibody aggregates known as immune complexes that your body targets and attacks. Normally, these immune complexes circulate through the bloodstream until being removed by the liver and other organs. In IgAN, however, they become trapped in the glomeruli.

What are the signs and symptoms of IgA nephropathy?
The most common sign is blood in the urine. The amount of blood may be so small that it is only visible with the aid of a microscope. Another common sign is swelling of the feet.

As loss of kidney function progresses, symptoms may include pain in the back below the ribs, increased need to urinate (especially at night), fatigue, nausea, swelling of hands and feet and high blood pressure.

How is IgA nephropathy treated?
Efforts to slow the progression of kidney damage may include limiting the amount of protein in the diet and, if present, careful control of high blood pressure through diet and medication. If these treatments are not enough after a few months, then corticosteroids, such as prednisone, may also be considered. Fish oil has also been used as a treatment. Discuss the use of any supplement and medication with your doctor. For patients who develop progressive kidney failure, treatment may consist of dialysis or a kidney transplant.

The success rate of transplants is good in these patients. Even though the IgA deposits reappear in the transplanted kidney in about half the patients within one year after the operation, the signs and symptoms of the disease remain mild. Loss of a transplanted kidney to recurrent IgA nephropathy is uncommon. The milder form of the disease seen after transplantation may be due to the use of anti-rejection drugs such as cyclosporine.

What is the outlook for patients with IgA nephropathy?
Twenty to forty percent of the patients develop end stage kidney failure about 20 years after the disease becomes apparent. Patients who have an increased level of creatinine in their blood at the time of their diagnosis are more likely to develop chronic kidney failure. It is harder to predict which of the patients who have normal levels of creatinine at the time of diagnosis will develop kidney failure. In general, a poor prognosis is expected for those patients who have high blood pressure, high urine protein, and a significant amount of damage present in their biopsy specimen.

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