IgA nephropathy, also known as Berger’s disease, is a chronic kidney disorder where immunoglobulin A (IgA) builds up in the kidneys, leading to inflammation and potential kidney damage. This autoimmune condition can vary widely in its severity, with some individuals experiencing only mild symptoms while others progress to more severe kidney disease. Understanding the factors that can trigger or exacerbate IgA nephropathy is crucial for managing the condition and preventing further kidney damage. In this blog, we will explore five IgA nephropathy triggers, including infections, food sensitivities, and more.
As usual, the references are in the hyperlinks.
By Majd Isreb, MD, FACP, FASN, IFMCP
IgA Nephropathy Triggers
Understanding IgA nephropathy
IgA nephropathy is an autoimmune disorder predominantly affecting mesangial cells. The disease process begins when the immune system erroneously produces abnormal IgA proteins. These proteins, perceived as foreign, instigate an immune response. Immune complexes formed in this process accumulate in the kidneys, attaching to mesangial cells, leading to inflammation and kidney tissue damage.
The ‘four-hit’ hypothesis of IgAN
The pathogenesis of IgAN is encapsulated in the “four-hit hypothesis,” which posits:
- Elevated levels of abnormal IgA1 (galactose-deficient IgA1 or gd-IgA1)
- Autoantibody production against this abnormal IgA1
- Formation of immune complexes involving these autoantibodies and CD89
- Deposition of these complexes in the glomerular mesangium, culminating in kidney damage
Significant to IgAN is dimeric IgA1, predominantly originating from the gut’s mucosa-associated lymphoid tissue (MALT). In fact, the site of gd-IgA1 production is presumed to be the Peyer’s patches of the gut and mesenteric lymph nodes.
The exact reason for abnormal IgA1 production remains unknown, but genetic and environmental factors likely contribute. This review article offers detailed insights into IgAN’s innate and adaptive immune mechanisms. It is freely accessible.
Five IgA Nephropathy Triggers
Infections: A Common IgA Nephropathy Trigger
One of the most well-known triggers for IgA nephropathy is infections, particularly those affecting the respiratory tract. Upper respiratory infections, such as the common cold or strep throat, can lead to an increased production of abnormal IgA antibodies. In individuals with a predisposition to IgA nephropathy, these antibodies can deposit in the kidneys, causing inflammation and damage. This response may occur within days or weeks following the infection, highlighting the importance of closely monitoring kidney function during and after an illness.
In addition to respiratory infections, gastrointestinal infections have also been linked to IgA nephropathy flare-ups. Bacterial or viral infections in the gut can similarly stimulate an overproduction of abnormal IgA, which can then accumulate in the kidneys. Dysbiosis in the gut can also be a trigger to IgA Nephropathy in individuals with predispostion.
Food Sensitivities: Hidden IgA Nephropathy Triggers
While not as widely recognized as infections, food sensitivities can also trigger IgA nephropathy in some individuals. Certain foods, particularly those that provoke an immune response, may lead to the formation and deposition of IgA in the kidneys. Gluten, found in wheat, barley, and rye, is one of the most commonly implicated food sensitivities in individuals with autoimmune conditions, including IgA nephropathy.
Soy, egg white, milk protein and oat have also been associated with kidney inflammation in sensitive individuals. Identifying and eliminating trigger foods from the diet can be a crucial step in managing IgA nephropathy. Working with a healthcare provider or nutritionist to identify food sensitivities through elimination diets or testing may help reduce flare-ups and protect kidney function.
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Stress: An Overlooked Trigger for IgA Nephropathy
Stress is often an overlooked factor in chronic diseases, but it can have a significant impact on autoimmune conditions like IgA nephropathy. Both physical and emotional stress can alter immune system function, potentially leading to increased production of abnormal IgA in predisposed individuals leading to subsequent kidney damage. Stress-induced flare-ups can occur due to various reasons, such as surgery, trauma, or even psychological stressors like anxiety or depression.
Managing stress through lifestyle modifications, such as regular exercise, mindfulness practices, and adequate sleep, can be beneficial for individuals with IgA nephropathy. Additionally, stress management strategies can help improve overall well-being, making it easier to cope with the challenges of living with a chronic kidney condition.
Environmental Factors: Triggers Lurking in Your Surroundings
Environmental factors, including exposure to certain chemicals and pollutants, can also act as triggers for IgA nephropathy. For example, exposure to air pollution, particularly fine particulate matter, has been linked to increased kidney inflammation and dysfunction in susceptible individuals. Similarly, contact with certain chemicals, such as those found in household cleaners or industrial products, may exacerbate IgA nephropathy.
Reducing exposure to environmental triggers can be challenging, but taking steps to minimize contact with pollutants and chemicals is essential. This might include using air purifiers, avoiding smoking or secondhand smoke, and choosing natural or organic cleaning products. Being mindful of environmental factors can help reduce the risk of flare-ups and protect kidney health.
Medications: Unintentional IgA Nephropathy Triggers
Certain medications can unintentionally trigger or worsen IgA nephropathy. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are commonly used for pain relief but can cause kidney inflammation and damage, particularly in individuals with pre-existing kidney conditions. They are also linked to dysbiosis. Overuse or prolonged use of these medications may lead to a worsening of IgA nephropathy symptoms.
Other medications, including some antibiotics can also lead to dysbiosis which in-turn can trigger flare-ups. It’s important for individuals with IgA nephropathy to consult their healthcare providers before starting any new medications and to discuss potential risks. Adjusting dosages or exploring alternative treatments may be necessary to protect kidney health.
The Bottom Line on IgA Nephropathy Triggers
IgA nephropathy is a complex condition with various triggers that can activate or exacerbate the disease. By understanding and identifying these triggers—such as infections, food sensitivities, stress, environmental factors, and certain medications—individuals with IgA nephropathy can take proactive steps to manage their condition and protect their kidney health. If you or a loved one has been diagnosed with IgA nephropathy, it’s essential to work closely with healthcare providers to develop a personalized management plan that addresses these triggers and reduces the risk of kidney damage.
