Q: My wife is 40 years old. She has been diagnosed for IgA nephropathy. Her creatinine level is 2.7 and potassium is 5.5. She has been prescribed the following medicines: Covance, Ecator, LDTOR, Renfor, Thyronorm 25, Omnacortil, Pantop 40 mg, Ostriol 0.25 mg and Becosule. After using the above medicines for 10 days, the creatinine was 2.5 and potassium is 4. Blood pressure is 144/82. Does she need to take hepatitis B and C vaccines to avoid jaundice? Will she develop End Stage Renal Disease (ESRD)? Can she carry on with the above medicines? How long will it take to develop ESRD? What diet should she take? What will be her life expectancy with these medicines? She is not a diabetic.

A:Management of IgA nephropathy involves intervention with non-immunosuppressive and immunosuppressive therapy (steroids). 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. Based on the information provided and taking serum creatinine value of 2.5 mg/dL into consideration, your wife has less than 25% of normal kidney function at her age. This does reflect advanced kidney disease. However, she still could be treated with a steroid (omnacortil, as in her case), 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. Unfortunately, in advanced stages of kidney disease, chances of response to these highly toxic immunosuppressive therapies become slimmer. Instead, the focus should be on managing the risk factors, which could help in delaying the progression of underlying kidney disease secondary to IgA nephropathy. This is achieved by blood pressure lowering medications in the form of Angiotensin Converting Enzyme inhibitors (ACE Is) or/and 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. It is also recommended to have a daily intake of 45-50 grams of protein as part of the dietary modification needed to delay the progression of kidney disease though these recommendations need to be tailored to the specific nutritional needs of the patient avoiding the risks of malnutrition. It is difficult to comment on the chances of progression of chronic kidney disease, secondary to IgA nephropathy to the stage of ESRD (End Stage Renal Disease) in your wife’s case though patients with significant impairment of kidney function at the time of the diagnosis and marked protein leakage in the urine are known to have rapid progression to the stage of ESRD.