IgA Nephropathy

What Is IgA Nephropathy?

[dropcap]I[/dropcap]gA nephropathy, also called Berger’s disease, is a primary renal disease that results when immunoglobulin A (IgA) forms deposits in the glomeruli, where it creates inflammation.

IgA nephropathy is characterized by recurrent hematuria (blood in urine), mild proteinuria (protein in urine), and glomerular changes,¹ but it is often a silent disease that may go undetected for many years.²

IgA is an antibody that helps the body fight infections.  As IgA builds up inside the small blood vessels of the kidney, glomeruli become inflamed and damaged.³

Q: What are glomeruli?

A: Glomeruli are the tiny units within the kidney where blood is cleaned. Blood enters the kidneys through arteries that branch inside the kidneys into tiny clusters of looping blood vessels. Each cluster is called a glomerulus, which comes from the Greek word meaning filter. The plural form of the word is glomeruli.

There are approximately 1 million glomeruli, or filters, in each kidney. The glomerulus is attached to the opening of a small fluid-collecting tube called a tubule. Blood is filtered in the glomerulus, and extra water and wastes pass into the tubule and become urine. Eventually, the urine drains from the kidneys into the bladder through larger tubes called ureters.⁴

IgA nephropathy can appear suddenly (acute glomerulonephritis) or get worse slowly over many years (chronic glomerulonephritis). Kidney disease impairs vitamin D activation in the body, resulting in bone loss.³

What Is IgA Nephropathy In Celiac Disease and/or Gluten Sensitivity?

• IgA nephropathy is an associated disorder in celiac disease and can be a presenting feature of celiac disease that brings the patient to the doctor.
• In untreated celiac disease there are elevated blood levels of IgA antibodies which if they form deposits in the kidney may cause IgA nephropathy.
• A study examining the relationship between IgA-antigliadin antibody and clinical data concludes that IgA-antigliadin antibody are associated with the progression of IgA nephropathy. Antireticulin and antiendomysium antibody tests were negative in all patients and control sera. Findings support the current concept about the pathogenesis of IgA nehpropathy, where the defective IgA production itself may be the primary and intestinal lesions as well as the production of IgA-antigliadin, the secondary phenomenon.¹
• The association between celiac disease and other immune disorders may be due to the sharing of a common genetic background, such as HLA antigens.
• However, in a very large study, involving 909 patients with celiac disease, it was found that the development of immune disorders in celiac disease was clearly related to the duration of exposure to gluten.⁵
• IgA nephropathy causes increased intestinal permeability (leaky gut) which may predipose the genetically susceptible person to active celiac disease.⁶

How Prevalent Is IgA Nephropathy In Celiac Disease and/or Gluten Sensitivity?

Celiac disease occurs in 3.6% of patients with IgA nephropathy (IgA NP), and 14% of HLA DQ2 positive patients with IgA nephropathy had celiac disease.⁷

What Are The Symptoms Of IgA Nephropathy?

IgA nephropathy is marked by these symptoms but may have no symptoms in the early stages:

• Fatigue that may come and go in early stage.
• Loss of appetite.
• Headache.
• Blood and protein in the urine.
• Hypertension.
• Swelling of hands and feet.
• Low blood cell count.

How Does IgA Nephropathy Develop In Celiac Disease and/or Gluten Sensitivity?

• IgA nephropathy results from unclear autoimmune mechanism.¹
• In the pathogenesis of IgA nephropathy, the defective IgA production itself may be the primary and intestinal lesions as well as the production of IgA-anti-gliadin, the secondary phenomenon.¹
• Increased intestinal permeability in IgA nephropathy may predispose genetically susceptible patients to celiac disease.⁸

Does IgA Nephropathy Respond To Gluten-Free Diet?

A gluten free diet had no apparent influence on the course of nephropathy.⁹

6 Steps To Improve IgA Nephropathy In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both IgA nephropathy and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.¹⁰
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.¹¹
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.¹¹
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.¹¹.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.¹¹
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.¹¹
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.¹¹[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

Certain medications used to control blood pressure to slow further kidney damage in IgA nephropathy deplete nutrients. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

CARDIOVASCULAR DRUGS

• Angiotensin-converting enzyme (ACE) inhibitors (Capoten®, Vasotec®, Monopril® and others) deplete Zinc.

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• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

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Discuss with your treating physician taking these supplements to improve nutritional status and prevent bone loss due to the adverse effects of IgA nephropathy.

• Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Calcium citrate is the best absorbed of calcium supplements. Calcium carbonate is a poor choice.
• Vitamin D3 as prescribed following blood test for status.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About IgA Nephropathy In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“IgA-antigliadin in patients with IgA nephropathy: the secondary phenomenon?” This study examining the relationship between IgA-AGA and clinical data concludes that IgA-AGA are associated with the progression of IgA NP. Antireticulin and antiendomysium antibody tests were negative in all patients and control sera. Findings support the current concept about the pathogenesis of IgA NP, where the defective IgA production itself may be the primary and intestinal lesions as well as the production of IgA-AGA, the secondary phenomenon.¹

“Celiac disease and HLA DQ in patients with IgA nephropathy.“ This study seeking to establish how common celiac disease is in patients with IgA nephropathy, and whether the possible association can be explained by similiar HLA DQ status demonstrates that although there is no increase in celiac-type HLA DQ, patients with IgA nephropathy carry a risk of developing celiac disease. It can be hypothesized that the increased intestinal permeability in IgA nephropathy may predispose genetically susceptible patients to Celiac Disease.¹²

CASE REPORT SUMMARIES

“Multiple immune disorders in unrecognized celiac disease: a case report.” This case report describes the course of a 34 year old female patient with unrecognized celiac disease and multiple extra intestinal manifestations, mainly related to a deranged immune function, including macroamilasemia, macrolipasemia, IgA nephropathy, thyroiditis, and anti-b2-glicoprotein-1 antibodies, that disappeared or improved after the implementation of a gluten-free diet.

After six months of controlled gluten free diet, the patient’s body weight increased 12 kg; laboratory investigations demonstrated normalization of serum amylase, serum lipase and immunoglobulin levels; antigliadin, anti-2-glicoprotein-1 and anti-thyreoglobulin antibodies were no longer detectable, but antiendomysial antibodies were still present. Endoscopy showed a normal appearance of duodenal mucosa, and duodenal biopsy revealed a partial recovery of duodenal morphology.

Due to the persistence of proteinuria (2.3 g/day), microscopic hematuria and hyaline and granular casts, a kidney biopsy showed that it was IgA nephropathy. After 18 months of gluten-free diet, antiendomysial antibodies disappeared; creatinine clearance increased, but proteinuria further worsened (2.9 g/day), and albumin levels were still low. After 24 months of gluten-free diet, a new duodenal biopsy showed complete recovery of villous architecture. Renal function further improved and proteinuria markedly decreased ). Amylase, lipase, and immunoglobulin levels were within the normal range. Anti-2-glicoprotein-1, anti-thyreoglobulin, antigliadin, antiendomysial and anti-TTG antibodies were undetectable. A coagulation study was normal.

Although both celiac disease and the other manifestations of a deranged immunity might be explained on the basis of a common genetic predisposition to this kind of disorders, some findings suggest that celiac disease itself is responsible for the initiation of the immunological response. Indeed, persistent stimulation by some proinflammatory cytokines, such as interferon  and tumor necrosis factor , could induce further processing of autoantigens and their presentation to T lymphocytes by macrophage-type immunocompetent cells. As a matter of fact, the prevalence of immune diseases among patients with celiac disease seems proportional to the time of exposure to gluten, and many immune alterations disappear following the recognition of celiac disease and appropriate treatment, just as it occurred in this patient.¹³

Sources:

1. Ots M, Uibo O, Metskula K, Uibo R, Salupere V. IgA-antigliadin in patients with IgA nephropathy: the secondary phenomenon? American Journal of Nephrology. 1999; Vol. 19 (4), pp. 453-8. [↩] [↩] [↩] [↩] [↩]
2. http://kidney.niddk.nih.gov/kudiseases/pubs/glomerular/ [↩]
3. National Library of Medicine [↩] [↩]
4. http://kidney.niddk.nih.gov/kudiseases/pubs/glomerular/ [↩]
5. La Villa G, Pantaleo P, Tarquini R, Cirami L, Perfetto F, Mancuso F, Laffi G. Multiple immune disorders in unrecognized celiac disease: a case report. World J Gastroenterol. 2003;9(6):1377-1380, Available at: http://www.wjgnet.com/1007-9327/9/1377.asp. Accessed Jan 3, 2005. [↩]
6. Collin P, Syrjanen J, Partanen J, et al. Celiac disease and Hla DQ in patients withIgA nephropathy. The American Journal of Gastroenterology. Oct 2002;97(10):2572-6. [↩]
7. Collin P, Syrjanen J, Partanen J, et.al. Celiac disease and Hla DQ in patients withIgA nephropathy. The American Journal of Gastroenterology. Oct 2002;97(10):2572-6. [↩]
8. Collin P, Syrjanen J, Partanen J, et al. Celiac disease and Hla DQ in patients withIgA nephropathy. The American Journal of Gastroenterology. Oct 2002;97(10):2572-6. [↩]
9. Collin P, Syrjanen J, Partanen J, et.al. Celiac disease and HLA DQ in patients with IgA nephropathy. The American Journal of Gatroenterology. Oct 2002;97(10):2572-6. [↩]
10. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
11. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
12. Collin P, Syrjanen J, Partanen J, et.al. Celiac disease and Hla DQ in patients withIgA nephropathy. The American Journal of Gastroenterology. Oct 2002;97(10):2572-6. [↩]
13. La Villa G, Pantaleo P, Tarquini R, Cirami L, Perfetto F, Mancuso F, Laffi G. Multiple immune disorders in unrecognized celiac disease: a case report. World J Gastroenterol 2003; 9(6): 1377-1380. [↩]