Even though IgA nephropathy (IgAN) puts 50% of its patients at risk of end-stage renal disease (ESRD) and dialysis within 10 to 20 years, IgAN-specific treatments are not available at this time. On a morning TV show for women on the Lifetime channel, called “The Balancing Act,” a nephrologist breaks down the disease and what treatments are commonly used at this time.* 

How does IgAN impact the body?

The disease affects the fine filter of the kidneys, known as the glomeruli. IgAN can cause IgA protein to deposit in the kidneys, damaging the glomeruli and leading to inflammation, scarring, and eventually compromised kidney function. Routine urine and blood tests can catch IgAN and may also be caught in those with high blood pressure or with blood in their urine.

It often leads to shock in patients who had no idea they were suffering from serious kidney disease, as not every patient shows signs of the disease, especially in its early stages.

What treatments are doctors prescribing at this time?

John Marsala, an IgAN patient, who was featured on the show, explains that he had been diagnosed with IgAN in 2005 and that his doctor wanted to put him on a high-dose steroid, known as prednisone, to manage disease progression. Weight gain, irritability, and insomnia were major side effects that came with this medication—affecting John’s quality of life much worse than his actual diagnosis.

Aside from steroids for inflammation and lifestyle changes, doctors may also recommend:

• Immunosuppressive medications to reduce the inflammatory response and IgA production
• Other medications meant to reduce blood pressure and the amount of protein in the urine 

None of these medications can improve or protect the kidney from further decline.

“This means we have a significant unmet need in the treatments we can offer our patients,” said Dr. Jonathan Barrat, a nephrologist at the University of Leicester in England, U.K. “They want new therapies that are safe that they can tolerate taking and that we can show can protect their kidneys against future deterioration and stop the need of dialysis or a kidney transplant.”

Where to focus future research

Dr. Barrat explained that researchers should concentrate on developing a therapy that stops the mechanisms that cause the development of the disease in the first place: the overproduction of IgA. IgA is an antibody that lines the surfaces of the mucosal membrane and plays a role in preventing bacteria from entering the body when secreted. 

The gastrointestinal system is the main production site of IgA, since it’s the largest mucosal membrane surface. A therapy that targets the abnormal IgA protein, which builds up in excess and may originate first in the gut, could help IgAN patients get the help they need. 

Marsala explained that the prednisone left him with unwanted side effects and lab tests indicating deteriorating kidney health. He was then given the option to enroll in a clinical trial, which he agreed to, and eventually saw indicators reflecting stable kidney health. He has since joined the IgA Nephropathy Foundation Board of Directors, where he continues to advocate for new treatments for the disease.

With a continued focus on the development of new therapies, the sense of hope Marsala now feels will be shared with others with IgA nephropathy.

*IgA Nephropathy Foundation. (2020, Dec. 9). BEHIND THE MYSTERY | IGA NEPHROPATHY [Video file]. Retrieved from https://www.youtube.com/watch?v=ENrKtaZ8-wA&t=1s