Q: I am 34 years old. I was recently diagnosed with IgA nephropathy after a kidney biopsy. I have 3.9 gm of protein in 24-hour urine and 1.2 mg/dl creatinine. My doctor told me that there are couple of medicines available to treat IgA but they have other side effects. How is this treated in India?

A:Management of IgA nephropathy involves intervention with non-immunosuppressive and immunosuppressive therapy. Indication for each of these therapies depends upon the severity of kidney disease which is based upon the estimated loss of kidney function, amount of protein leakage in the urine (proteinuria) and most important, the kidney biopsy findings. Non-immunosuppressive therapy involves usage of blood pressure lowering medications in the form of Angiotensin Converting Enzyme inhibitors (ACE Is), [example- Altace] or Angiotensin Receptor Blockers (ARBs) which help delay the progression of kidney disease by reducing the amount of protein leakage in the urine besides lowering the blood pressure. Immunosuppressive medications are indicated for progressive active disease despite the usage of ACE Is and/or ARBs, or a severe disease at the time of the diagnosis itself as obvious from a severe degree of proteinuria or from the markers of active disease noted on the kidney biopsy. The first line of immunosuppressive medication used is steroids (prednisone) which is usually prescribed for a period of 6 months. Other standard immunosuppressive agents include cyclophosphamide and azathioprine, each of which is administered in combination with a steroid if the patient does not respond adequately to the steroid therapy alone. All of these medications have serious toxic side-effects and hence any treatment regimen followed requires strict compliance and close monitoring under the supervision of a nephrologist. In addition, clinical trials have suggested probable minor benefit from fish oil which could be tried if there is a continued gradual deterioration in the kidney function despite ACE Is and/or ARBs and steroid therapy. However, fish oil could be used in combination with ACE I/ARB at an earlier stage of treatment. These standard treatment protocols for IgA nephropathy are being practiced in India.