Treatment of IgAN

IgA nephropathy is a common cause of glomerulonephritis. Although it is a benign disease in most patients, chronic renal failure and ESRD occur in about 20-40% of patients within 20 years of presentation. Currently, no cure exists for IgA nephropathy, but therapies that can delay the onset of need for dialysis and transplantation are available.
High blood pressure medications. One area where there is near complete agreement is on the subject of blood pressure. Impaired kidneys are very good at secreting a hormone which deliberately raises blood pressure. It is imperative that any treatment for controlling high blood pressure be followed rigorously, as high blood pressure itself further adds to the damage being caused in the kidneys, and it is an independent risk factor for ESRD (not to mention other cardiovascular complications). In addition to lowering blood pressure, some specific high BP medications appear to have renal-protective and/or antiproteinuric effects. Generally, this applies to all the medications of a given class, namely, the ACE inhibitors, and also their close cousins, the Angiotensin II Receptor Blockers. In some cases, some doctors are experimenting with using both at the same time. You can expect maximum reduction of proteinuria (up to about 40-50%) about four weeks after starting an ACE inhibitor. Basically, for maximum protection against further damage to your kidneys caused by high blood pressure, your nephrologist will want to reduce your BP as much as possible without putting you at risk of fainting. This will be a BP that is lower than it would be for someone without kidney disease. On the other hand, it should be said that the benefits of going below 130/80 are very minimal. Sometimes, blood pressure is treated down so much that it has a significant negative effect on quality of life of the patient.

Dietary restrictions. A lower-protein diet is commonly prescribed to patients who have more advanced renal failure (often referred to as pre-esrd). However, the use of a low-protein diet in mild to moderate IgAN is controversial, as there is no solid evidence that it has any value, and in some cases, it can actually be harmful (might cause growth retardation in children). Your nephrologist will tell you if you need to be on a low protein diet. If you are hypertensive or have edema, you may be asked to reduce sodium intake. An actual renal diet (low protein, low potassium, low sodium, low phosphorus, high calories) is not required until IgAN has progressed to more advanced renal failure. The purpose of such a renal diet is not to delay progression of IgAN, but mainly to minimize the uremic symptoms of chronic renal failure (which may or may not extend the time until dialysis is needed). Unless you are specifically told to restrict something in your diet, there is no need to do so. There is no evidence that any food causes or affects IgAN, however, some people do believe an antigenic diet may be useful, and some nephrologists can be found who will suggest it (this is not considered mainstream medicine at present).