Definition of IgA nephropathy

Definition of IgA nephropathy

IgA nephropathy is a kind of autoimmune diseases which indicates the glomerular mesangial area focusing on

the deposition of IgA or IgA, probably existing other immune globulins in glomerular mesangial area. The disease is divided into two catogories, namely primary IgA nephropathy and secondary IgA nephropathy. The primary one is caused by the kidney itself. The secondary one is caused by other diseases, such as purpura nephritis, familial IgA nephropathy and so on.

Causes of IgA nephropathy

Immunoglobulin A (IgA) is an antibody that plays a key role in your immune system by attacking invading pathogens and fighting infections. But in IgA nephropathy, this antibody collects in the glomeruli, causing inflammation (glomerulonephritis) and gradually affecting their filtering ability. Researchers don't know exactly what causes IgA deposits in the kidneys, but these conditions or factors may be associated with the development of IgA nephropathy:

Genes, because IgA nephropathy is more common in some families and in certain ethnic groups.

Liver diseases, including cirrhosis, a condition in which scar tissue replaces normal tissue within the liver, and chronic hepatitis B and C infections

Celiac disease, a digestive condition triggered by eating gluten, a protein found in most grains.

Dermatitis herpetiformis, an itchy, blistering skin disease that stems from gluten intolerance.

Infections, including HIV infection and some bacterial infections.

Signs and symptoms of IgA nephropathy when kidney function is impaired include:

● Cola- or tea-colored urine (caused by red blood cells in the urine)

● Repeated episodes of cola- or tea-colored urine, sometimes even visible blood in your urine, usually with an upper respiratory tract infection or, less often, gastroenteritis.

● Pain in the side(s) of your back below your ribs (flank)

● Foam in the toilet water from protein in your urine

● Swelling (edema) in your hands and feet

● High blood pressure. Usually there is no abnormality to find although occasionally there may be hypertension. This is uncommon at presentation but may occur if renal function fails. If glomerulonephritis leads to nephrotic syndrome there will be oedema.

There's no cure for IgA nephropathy and no definitive way of knowing what course the disease will take. Some people experience complete remission and others live normal lives with low-grade blood or protein in their urine (hematuria or proteinuria). Treatment with a number of medications can slow the progress of the disease and help you manage symptoms such as high blood pressure, protein in the urine (proteinuria), and swelling (edema) in your hands and feet.

● Immunosuppressants

Corticosteroid medications, such as prednisone, and other potent drugs that suppress the immune response (immunosuppressants) may be used to help protect your kidney function. But these drugs can cause a range of serious side effects, such as high blood pressure or high blood sugar, so their benefits must be carefully weighed against the risks. The ultimate goal is to avoid the need for kidney dialysis or kidney transplantation. But in more advanced cases, dialysis or transplant may be necessary.

● Treatment in our hospital

Being different from the traditional treatments which often focus on the elimination of some symptoms such as protein in urine and blood in urine, the proper treatment starts from the very cause of the IgA nephropathy, which means the proper treatment works on repairing the glomerular capillary and mesangial cells in the kidney.

The treatment method is a combined treatment which integrates Chinese and western therapy and makes Chinese medicine as the main therapy. The four steps of the treatment are enlargement of blood vessel, anti-inflammatory, anti-freezing and elimination of harmful substance. In order to enhance the efficacy of the treatment, some other therapies are developed, among which the best and the most advanced therapy is called Micro-Chinese medicine Osmotherapy which work on the blockage of renal fibrosis.

It is proved that so long as the damaged mesangial cells and glomerular capillary are recovered, the function of kidney will recover and so will the condition of the disease. Once the disease is cured, it is not likely to relapse, as both the symptoms and the cause of the disease is cured.

 ● Prognosis

In the majority, the disease is benign but end- stage renal failure (ESRF) occurs by 10 years in 15 to 20% and by 20 years in around 30%. These figures are based on those who have had renal biopsies and so those with milder disease presumably do better than this. Those with microscopic haematuria seem to fare worse than those with macroscopic disease. This could be because they present later. Other features of poor prognosis are sustained hypertension, impaired renal function, persistent haematuria and proteinuria in excess of 1 g a day. Histological findings of interstitial fibrosis, tubular atrophy and glomerular scarring give a worse outcome. As with other glomerular diseases, the risk of progression is more closely correlated with tubulointerstitial pathology than with glomerular disease.

Pregnancy is usually uneventful unless there is poorly controlled blood pressure, a bad histological picture or poor renal function with a creatinine clearance of less than 70 ml a minute. ACE inhibitors and angiotensin-II receptor antagonists must be stopped before trying to conceive as they are markedly teratogenic.

● Prevention

Because the cause of IgA nephropathy isn't known, it's not possible to prevent it. But if you have a family history of IgA nephropathy, talk with your doctor to find out what steps you can take to keep your kidneys healthy, such as reducing high blood pressure and keeping your cholesterol at healthy levels.

● Hope through research

In recent years, researchers have learned much about kidney disease. Researchers are studying families in which IgA nephropathy is prevalent in order to understand genetic factors that may influence the disease. Other researchers are working to understand how the polyunsaturated fatty acids found in fish oils may work to reduce inflammation in diseases like IgA nephropathy and rheumatoid arthritis. Clinical trials are under way to test the effectiveness of MMF in reducing protein in the urine and slowing the progression of kidney disease in people with IgA nephropathy.