Your Guide to Medications for IgA Nephropathy and C3G

The human body is more than a collection of organs that each does one thing. They’re all part of a greater system. So, how well each of your organs does its job makes a big difference in how the rest of your body is able to go about its business.

Your kidney health goes hand-in-hand with your body’s overall well-being. So, when your kidneys aren’t functioning as effectively as they used to, the effects can reverberate around your body.

“Our bodies are an interconnected system, and our kidneys are responsible for tasks that impact more of our bodies than you may have imagined,” says nephrologist Jonathan Taliercio, DO.

Often, a change in your medication regimen — more of some things, less of others — can help restore balance. Medications can help pick up some slack that your kidneys may not be up for anymore.

What can you expect to find in your medicine cabinet after being diagnosed with IgA nephropathy (IgAN) or C3G? And what medications should you avoid? Dr. Taliercio shares some advice.

What your doctor may recommend

The medications your provider suggests for you will likely depend on the severity of your kidney disease and the symptoms you’re experiencing. The goal should be to help ensure your body gets what it needs while keeping side effects to a minimum.

“Your kidneys do a lot of great things, so when they’re not functioning as well as they should, your provider will probably look to supplement some of that function with medication,” Dr. Taliercio says.

Depending on your symptoms and your disease progress, he adds that your provider may suggest medications to help perform some of your kidneys’ essential functions.

Control acid buildup

Our diet and our bodies naturally produce acid. One of your kidneys’ jobs is to help clear that acid. When your kidneys aren’t working to their fullest, the acid accumulates in your body, a condition called metabolic acidosis.

That extra acid can cause symptoms like fatigue, confusion, loss of appetite and more. Over time, acid can wear away at your bones, leading to a condition called renal osteodystrophy, which is associated with bone pain and fractures.

If you remember a bit from chemistry class, bases neutralize acids. So, your provider may recommend a base, like sodium bicarbonate or sodium citrate, to treat the acids and protect your bones.

Manage anemia

When you have IgA nephropathy, C3G or other kidney diseases, you may be at higher risk for anemia (low number of red blood cells).

“The kidneys make a hormone called erythropoietin, which tells your bones to make red blood cells,” Dr. Taliercio explains. “When you have kidney disease, you may not make enough erythropoietin, or you may have decreased sensitivity to the hormone that’s there, which leads to anemia.”

Classic symptoms of anemia include:

• Feeling very tired or weak.
• Shortness of breath.
• Headaches.
• Skin that’s more pale than usual.
• Sweatiness, dizziness or faintness.

Your provider may recommend boosting your red blood cell count with synthetic erythropoietin therapy or iron supplements.

Keep blood pressure in check

High blood pressure is very commonly connected to kidney disease. After all, your kidneys are responsible for filtering sodium from your body. As sodium builds up, it raises your blood pressure, which can lead to heart attack, stroke, eye damage and more.

Your provider may prescribe medication to lower your blood pressure. Common medications include:

• Angiotensin-converting enzyme (ACE) inhibitors.
• Angiotensin II receptor blockers (ARBs).
• Thiazides or loop diuretics (“water pills”).
• Calcium channel blockers (CCBs).

Remove protein from urine

Some medications, called renin-angiotensin system (RAS) inhibitors may be used to treat high blood pressure and protein in the urine, (proteinuria), a classic finding in both IgA nephropathy and C3G.

“RAS inhibitors are generally seen as some of our first-line medications that are effective for treating both high blood pressure and proteinuria,” Dr. Taliercio notes.

Additionally, a certain class of medications originally intended to treat people with diabetes is gaining traction for use in people with kidney disease. They’re called SGLT2 inhibitors, and they go by names like:

• Canagliflozin (Invokana®).
• Dapagliflozin (Farxiga®).
• Empagliflozin (Jardiance®).

“Aside from reducing protein in the urine, they protect the kidney by decreasing the pressure in the nephron, which is the building block of the kidney,” Dr. Taliercio says.

Suppress immune response

IgA nephropathy and C3G are both autoimmune diseases.

If you think of your immune system like a pot of water on the stove, it’s generally set to a slow boil. When you have an infection, your immune system turns up the heat to defend you from the threat. When the infection clears, it returns to a slow boil — simmering away but ready to roar again the next time an intruder comes along.

But when you have an autoimmune disorder, the burner is stuck on high heat. Your pot of water is on a hard boil all the time. It creates loads of IgA protein to fight off bacteria and viruses. But as there aren’t actually any germs to fight off, that IgA builds up in your kidneys.

In some cases, Dr. Taliercio says that providers may prescribe immunosuppressant medications, typically steroids like prednisone. These medications are used to turn down the heat on the burner. Steroids lower your immune system’s response, giving your kidneys a chance to do their work without being overloaded with IgA.

“In the short term, steroids can help inflammation and calm things down,” he continues. “But prolonged used can cause some pretty serious side effects that we try to avoid.”

Among the side effects associated with steroids are:

• A lowered ability to fight infections.
• Bone loss.
• Cataracts.
• Diabetes.
• Insomnia.
• Poor wound healing.
• Weight gain.

Some newer steroids have been developed that attempt to suppress immune system response with fewer side effects.

Medications to avoid or limit

In addition to new medications, your provider will likely counsel you to eliminate or avoid other ones to protect your kidney function.

NSAIDs

Even for people with well-functioning kidneys, nonsteroidal anti-inflammatory medications (NSAIDs) shouldn’t be used for more than a week because of the increased risk of kidney damage.

When you’re living with IgA nephropathy, C3G or other kidney diseases, NSAIDs should be avoided entirely.

Common NSAIDs include:

• Ibuprofen (known by brand names such as Motrin® and Advil®).
• Naproxen sodium (known by the brand name Aleve®).

Certain heartburn meds

Medications called proton-pump inhibitors that are used to treat ulcers and heartburn may need to be reconsidered when you have IgA nephropathy, C3G or another kidney disease.

Common proton-pump inhibitors include medications that end in “-ole” like:

• Esomeprazole (Nexium®).
• Lansoprazole (Prevacid®).
• Omeprazole (Prilosec®).
• Pantoprazole (Protonix®).
• Rabeprazole (AcipHex®).

IV contrast

If you’ll be having a medical procedure like a CT scan, cardiac catheterization or another test that uses IV contrast dye, make sure your provider knows you have kidney disease. They may need to adjust the type or amount of dye you receive or have other instructions for you to follow related to your procedure.

Medication needs may differ from person to person based on your type of kidney disease and how it’s impacting your body and your life. Your provider will monitor you closely and discuss strategies and options.