IgA Nephropathy

What is IgA Nephropathy?

IgA nephropathy, also called Berger disease, is a kidney disease in which IgA, a type of antibody, deposits in the glomeruli, the kidney's filtering units, and causes inflammation and scarring.^{[1, 2]} It is the most common primary glomerular disease in the world.^[3]

The course varies a great deal. Some people have mild disease for decades, while others progress to kidney failure.^{[1, 2]} For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Common symptoms

Many people have no symptoms, and the disease is found when a urine test shows blood or protein.^[4] When symptoms appear, they can include visible blood in the urine, often along with a cold, sore throat or stomach infection, plus foamy urine, swelling and high blood pressure.^{[1, 4]}

Fatigue and swelling are more likely as kidney function declines.^[1]

Causes and risk factors

The exact cause is not known. Current research suggests a multi-step process in which an abnormal form of IgA1 is made in the body's mucosal immune system, antibodies attach to it, and the resulting immune complexes lodge in the kidney and trigger inflammation.^{[2, 5]}

The disease most often appears in younger adults, and it is more common in people of East Asian ancestry.^{[1, 4]} Genetics play a role, and infections may trigger episodes of visible blood in the urine.^{[2, 4]}

How it is diagnosed and treated conventionally

IgA nephropathy can only be confirmed by kidney biopsy, which shows IgA deposits in the glomeruli. Doctors also measure urine protein, blood pressure and kidney function.^{[2, 4]}

Treatment centers on supportive care: blood pressure control, medicines that lower protein loss (ACE inhibitors or ARBs), and lifestyle measures such as limiting salt, not smoking and weight control.^{[2, 4]} A Cochrane review found that blocking the renin-angiotensin system probably lowers protein loss in the urine.^[6] People at higher risk may be offered a course of steroids, though their benefit is debated and serious side effects are common.^{[2, 3]} Newer drugs that target the immune and complement systems or protect the kidney have recently been approved.^{[4, 7]} Your nephrologist directs all of this.

Why IgA Nephropathy calls for a whole-person approach

IgA nephropathy involves both an immune process that damages the kidney and the long-term strain of chronic kidney disease, so recent reviews describe treatment that addresses both.^[7] Quality of life is also affected by symptoms and by the burden of long-term monitoring and medication.

The clinic's supportive care can only address the second part, symptoms and day-to-day wellbeing. It does not target the kidney disease itself.

Immune activity in the gut and airways

The disease is thought to start with abnormal IgA made in mucosal tissue, and infections of the throat or gut can bring on visible blood in the urine.^{[4, 5]} This is an area of active research, and no integrative therapy has been shown to change it.

Blood pressure and kidney protection

Blood pressure control and lower sodium intake are central parts of care.^{[2, 4]} Anything we do must fit with your kidney diet and blood pressure plan.

Medication burden

Steroids and other immune-suppressing drugs can cause serious side effects, including infection.^{[3, 7]} Supportive care has to be planned around them.

Fatigue, sleep and mood

Chronic kidney disease is commonly accompanied by fatigue, poor sleep and low mood. Some acupuncture-related research has looked at these symptoms in people with kidney disease, though not in IgA nephropathy specifically.^{[8, 9]}

Acupuncture as supportive care in IgA Nephropathy

What the research shows

We found no clinical trials of acupuncture in IgA nephropathy. Acupuncture has not been shown to protect kidney function or to reduce protein or blood in the urine.

Studies in chronic kidney disease in general are limited. A Cochrane review of 24 trials in adults with stage 3 to 5 chronic kidney disease, mostly people on dialysis, found very low quality evidence that acupressure reduced depression, fatigue and sleep problem scores in the short term. The authors said the evidence was too weak to draw firm conclusions and that reporting of side effects was incomplete.^[8] A systematic review of 9 studies reported benefits for quality of life, fatigue and sleep, and no significant change in serum creatinine or glomerular filtration rate.^[9]

How acupuncture may work

For IgA nephropathy, no mechanism has been tested. Acupuncture is generally proposed to act through the nervous system's handling of stress, sleep and discomfort, and these are proposed explanations only.

What treatment involves

Treatment uses fine, sterile, single-use needles, with sessions usually lasting about 20 to 40 minutes. A course of several visits is followed by reassessment of whether it is helping with the symptom you want to address.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[10] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). Also tell us if you take steroids or other immune-suppressing medicine, have swelling, or are on dialysis.

Ayurvedic medicine as supportive care in IgA Nephropathy

The Ayurvedic view

Ayurveda has no classical name for IgA nephropathy. In Ayurvedic texts, kidney and urinary conditions are discussed under the concept of mutravaha srotas, the channels said to carry urine. These are traditional frameworks, not biomedical diagnoses.

Therapies that may be used

Care for a kidney patient is limited to gentle, supportive measures that fit your kidney diet:

• Regular daily routine and consistent sleep and waking times
• Stress-reducing practices such as breathing exercises and relaxation
• Warm oil massage for comfort, where appropriate

Herbal preparations and Panchakarma need special caution. Panchakarma is not appropriate during pregnancy, acute illness or frailty. With reduced kidney function, fluid or salt shifts from cleansing procedures can be harmful, so we would not use them unless your nephrologist agrees.

What the research shows

We found no clinical trials or systematic reviews of Ayurvedic medicine for IgA nephropathy, so any benefit is unknown. Quality is a real concern. About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic, and metal-containing products were more common among rasa shastra preparations.^[11] Heavy metal contamination of herbs and supplements is a recognized cause of kidney injury.^[12]

Herbal medicine as supportive care in IgA Nephropathy

Herbs and formulas that have been studied

Chinese herbal medicine has been studied in IgA nephropathy, mainly in China. Studied products include tripterygium wilfordii (thunder god vine) preparations, Huai Qi Huang (a compound containing a fungus, wolfberry and Polygonatum), and compound formulas used for patterns such as qi and yin deficiency.^{[13, 14, 15]}

What the research shows

The evidence is limited and comes mostly from small, short trials in China. A Cochrane review of non-immunosuppressive treatments found that traditional Chinese medicines gave small benefits to kidney function against placebo or no treatment, but the benefit was no longer evident compared with standard care. The authors said the trials were few, small and too short to judge long-term benefit.^[6]

Tripterygium has the most data. A meta-analysis of 4 trials (188 participants) reported higher remission rates and lower protein loss, and a later meta-analysis of 30 trials reported better remission and less proteinuria than ACE inhibitors, steroids or mycophenolate. The earlier analysis said its results should be interpreted with caution, and the later one said the quality of the included studies limited its conclusions.^{[13, 16]} In that later analysis, tripterygium combined with ACE inhibitors or ARBs also had more adverse reactions than control.^[16]

A 12-week trial of 45 adults with mild disease found that Huai Qi Huang reduced protein and blood in the urine compared with no treatment, with no obvious adverse events. It had no placebo and was small.^[14] In a double-blind trial of 131 people with a Chinese-medicine pattern of qi and yin deficiency, a compound tablet lowered urine protein about as much as the ACE inhibitor fosinopril.^[15]

Safety and herb-drug interactions

Herbal safety is a major concern in kidney disease. Some herbs contain nephrotoxic substances such as aristolochic acids and can cause acute kidney injury, chronic kidney disease and urinary tract cancer. Contamination, adulteration and incorrect processing add to the risk.^{[17, 18]} Some herbs can also raise blood pressure or potassium levels in people with kidney damage.^[18]

For these reasons, no herb should be started without your nephrologist knowing, and any herb needs review against your blood pressure medicines, steroids and other immune-suppressing drugs.^[19] Tripterygium is a potent preparation that should be used only under specialist supervision. Tell us if you are pregnant or breastfeeding, or have liver disease.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine describes patterns such as qi and yin deficiency or damp-heat that were used to select herbs in some of the trials above.^[15] Ayurveda would speak of imbalance in the urinary channels or in digestion.

Researchers instead study IgA1 production in mucosal tissue, immune complexes, complement activation and scarring in the glomerulus.^[5] No study has shown that a traditional pattern corresponds to any of these processes.

How this care fits with your medical care

The clinic's role is complementary. We do not diagnose IgA nephropathy or manage kidney function, prescribe or change medicines, or replace your nephrologist. Do not stop or change blood pressure medicines, steroids or other prescribed treatment without your prescriber.

Please bring your diagnosis, recent kidney function and urine test results, biopsy report if you have one, and a full list of medicines and supplements. Tell us about your kidney specialist so we can keep supportive care within your treatment plan.

When to seek urgent medical care

Some symptoms point to rapidly worsening kidney disease or a serious complication and need prompt medical evaluation.^{[1, 4]}

• Visible blood in the urine, such as dark, cola-colored or red urine, that is new or does not clear
• Much less urine than usual, or sudden swelling of the face, legs or abdomen
• Severe headache or very high blood pressure readings
• Fever or other signs of infection while on steroids or immune-suppressing medicine
• Nausea, vomiting, confusion or severe tiredness that is new or worsening

For emergencies, including chest pain, trouble breathing or fainting, call 911 or go to the nearest emergency department.