Can IgA Nephropathy Be Reversed?

There is no cure or reversal for IgA nephropathy (Shepherd’s disease). However, many people achieve remission, which is when disease progression and kidney damage slows.

Once kidney scarring (fibrosis) develops, it becomes permanent. The scar replaces healthy kidney tissue with stiff tissue that no longer filters your blood as it should.

Remission means that the disease has become less active.

During remission, the amount of blood and protein flowing into your urine due to IgA nephropathy decreases. Kidney function usually stabilizes, helping to protect the healthy kidney tissue you still have. This reduces your risk of long-term complications.

For children, remission may occur spontaneously. For most people, remission occurs with treatment.

About 20% of people with IgAN progress to end-stage renal disease within 10 years. However, with treatment and close monitoring, it is often possible to slow or stop further damage and preserve kidney function for many years.

1. Take blood pressure medication

Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are blood pressure medications that reduce stress on your kidneys. Reducing pressure inside your kidneys’ filters, the glomeruli, reduces urine protein and helps limit kidney damage.

Here are examples of medications:

• Prinivil (lisinopril)
• Vasotec (enalapril)
• Cozaar (losartan)
• Diovan (valsartan)

2. Use treatments targeted to the immune system

If you are at higher risk of kidney damage, your doctor may prescribe immune-calming medications.

Tarpeyo (budesonide) calms the immune system where abnormal IgA is produced. Depending on the case, your provider may instead order a low-dose steroid like Medrol (methylprednisolone).

Fabhalta (iptacopan) targets a different immune pathway that causes inflammation in the kidneys. This is an option if you need immune treatment without steroids.

3. Try new IgAN-specific therapies

In the past, IgAN care focused primarily on controlling blood pressure and slowing kidney damage. Today, new drugs target the disease more directly. These include:

• Endothelin receptor antagonists (ERA): ERAs like Vanrafia (atrasentan) and Filspari (sparsentan) help relax the blood vessels in your kidneys, reducing protein in your urine (proteinuria) and slowing kidney damage. Filspari (sparsentan) is unique because it acts as both an ERA and an angiotensin receptor blocker (ARB). Because it already includes the action of ARBs, you should not take it with ACE inhibitors.
• SGLT2 inhibitors: Researchers initially developed SGLT2 inhibitors like Jardiance (empagliflozin) and Farxiga (dapagliflozin) to treat diabetes. But these medications can also protect your kidneys by reducing proteinuria, even in people without diabetes. You can take them with ACE inhibitors or ARBs.

4. Consider emerging therapies and clinical trials

Voyxact (sibeprenlimab) is a newer injection given every four weeks. It works early in the disease process by targeting the APRIL protein, which helps reduce abnormal accumulation of IgA. The U.S. Food and Drug Administration (FDA) granted accelerated approval based on the drug’s ability to reduce urinary proteins. Ongoing trials are studying whether it protects kidney function in the long term.

If you would like to explore ongoing studies, you can search Clinicaltrials.gov to view active trials by location and eligibility.

To see if your kidneys are healing, doctors can do the following three things:

1. Test your urine for protein and blood

Providers check your urine for protein with spot urine tests like uPCR or uACR. They may also ask for a 24-hour urine sample. Treatment plans aim to keep protein levels below 0.3 to 0.5 grams per day.

Dehydration, infections and strenuous exercise can also increase urinary protein levels. For this reason, providers monitor trends over time rather than a single outcome.

Providers also order periodic urine tests to check for microscopic blood not visible to the naked eye.

2. Test your kidney function

Estimated glomerular filtration rate (eGFR) is a blood test that measures how quickly your kidneys filter waste. Rather than looking for a single number, providers monitor eGFR values ​​over time. The treatment goal is minimal annual decline.

3. Measure your blood pressure

High blood pressure can damage the small blood vessels in your kidneys. Providers generally recommend keeping blood pressure below 130/80, but often set a goal below 120/70 for people with IgAN.

Early diagnosis, close monitoring and newer treatments can slow progression and reduce the risk of complications. Here are some steps you can take to protect your kidneys:

• Limit your sodium intake to 2,300 milligrams per day and choose fresh foods over processed foods.
• Treat infections early.
• Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil or Motrin (ibuprofen) and Aleve (naproxen).
• Stay hydrated and active.
• Avoid smoking.
• Schedule regular visits to a nephrologist (kidney specialist) for monitoring.
• Ask your provider about new treatment options or clinical trials.

Call your nephrologist if:

• You notice dark or cola-colored urine.
• You develop new or worsening swelling in your legs, ankles, or eyes.
• Your home blood pressure readings exceed your target range.