Skill Checkup: A 56-Year-Old Man With Primary IgA Nephropathy and Fatigue, Abdominal Pain, and Frothy Urine

A. Brent Alper, Jr, MD, MPH


May 01, 2023

According to Kidney Disease Improving Global Outcomes (KDIGO) guidelines, uptitrating an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to the maximum tolerated dose is indicated for persistent proteinuria despite treatment of primary IgA nephropathy with immunosuppression. Lifestyle modifications (eg, normalizing weight, regular exercise, smoking cessation, reducing/eliminating analgesic use) must be employed in all patients with IgA nephropathy to improve control of hypertension and proteinuria. Patients must be counseled appropriately on all lifestyle modifications and should be referred to outside support and structured programs with heavily structured follow-up as needed.

Other than dietary sodium restriction to < 2 g/d, no specific dietary intervention has been shown to alter outcomes in IgA nephropathy.

Dual RAS-blocker regimens are generally not recommended in IgA nephropathy with persistent proteinuria. Even though they decrease proteinuria, this type of regimen is associated with greater risk for acute kidney injury and hyperkalemia.

Calcium channel blockers are not indicated as first-line agents for management of hypertension in patients with IgA nephropathy.


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