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Immunoglobulin A is an antibody that helps the body fight infections. Nephropathy is the clinical term for kidney disease, a condition where there is a decline in how well the kidneys work.
Immunoglobulin A nephropathy (IgA nephropathy) is an autoimmune disease where the body synthesizes defective immunoglobulin A. This defective antibody attracts other antibodies that bind to it and form clumps (called immune complexes).
These clumps accumulate in the kidneys and clog tiny blood vessels called glomeruli. In response, the immune system attacks glomeruli, and the glomeruli become inflamed and damaged. When this occurs, the kidneys can leak blood and protein into the urine. Scar tissue can also form in the kidneys, reducing their ability to function normally.
While the disease is often slow to progress, a significant number of people with IgA nephropathy progress to kidney failure, late-stage kidney disease that requires treatment with dialysis—and in some cases, kidney transplant.
There is no cure for IgA nephropathy, but there are medications that can help slow the progression of kidney damage. Here, we look at what some of those medications are and how they work.
Blood pressure medications
Blood pressure is the force that the blood circulating through the body exerts on the inner walls of the arteries (the blood vessels that carry blood from the heart to the rest of the body).
By releasing certain hormones and removing excess fluid from the blood, the kidneys are essential to keeping blood pressure within a healthy range. When the kidneys begin to decline in function, blood pressure can become elevated.
Blood pressure that is too high for too long is a serious health concern. It can cause damage to the cardiovascular system, increasing the risk of heart attack, stroke, and other cardiac events. It can also damage the eyes.
Additionally, blood pressure has a cyclical relationship with kidney disease—kidney disease increases blood pressure, and elevated blood pressure causes further damage to the kidneys.
Medications that lower blood pressure can play an important role in the management of kidney disease, including IgA nephropathy. These medications can include:
- Diuretics. These are drugs that help remove excess sodium and fluid from the body, which helps reduce blood pressure. They are sometimes called water pills.
- ACE inhibitors. Angiotensin-converting enzyme (ACE) inhibitors help your body block a specific enzyme that can raise your blood pressure.
- Angiotensin II receptor blockers (ARBs). As the name implies, these medications block a hormone called angiotensin II, which helps control muscle contractions along the vascular system. Blocking this hormone causes the veins and arteries to relax, allowing more blood to pass through with each pump of the heart, lowering blood pressure.
Diuretics are sometimes taken in combination with ACE inhibitors and ARBs.
Drugs that act on the immune system
IgA nephropathy is considered an autoimmune disease, a disease where the immune system attacks and damages healthy tissues—in this case, the glomeruli. Medications like corticosteroids and immunosuppressants are sometimes prescribed to decrease immune system activity and inflammation and reduce this damage.
Finding the right treatment
IgA nephropathy is a different experience for every person, and there is no best treatment, only the treatment that is best for a particular person at a particular time. Your healthcare providers can help you find the right treatment.
Treatment of IgA nephropathy will be overseen by a nephrologist, a healthcare provider who specializes in the treatment of kidney disease, but it will likely involve other providers and specialists who can help you address different areas of managing the disease, including cardiovascular health, a kidney-healthy diet, and other conditions that exist alongside IgA nephropathy.
