IgA nephropathy (IgAN) progression usually worsens slowly over 10-20 years. Early diagnosis, treatment, and monitoring can help preserve kidney function.
A healthcare provider may detect IgAN during routine urine testing before symptoms develop. As it progresses, you may notice:
- Blood in your urine (pink, red, or cola-colored)
- Fatigue
- Foamy urine
- Swelling in your face, hands, or legs
Blood in your urine may follow infections like colds or sore throats, which activate the immune system.
IgAN often progresses slowly over 10-20 years, but the course is unpredictable. Some people live for decades with little change in kidney function, while others experience a gradual decline.
Without treatment, IgAN raises the risk of chronic kidney disease and kidney failure. However, early treatment can significantly slow progression.
About 20-50% of people progress to end-stage kidney disease within 20 years of diagnosis. Many people never experience kidney failure. But those who do typically require dialysis or a transplant.
Some studies suggest IgAN may reduce life expectancy by six years on average. However, individual risk varies. Many people live full lives, especially with consistent monitoring and treatment. New IgAN-specific treatments expand options and improve outlook.
Early IgAN may not cause symptoms, so providers typically rely on regular blood and urine lab tests every three to six months to monitor your disease activity. They’ll look for these five indicators that your condition could be getting worse:
1. Protein in the Urine
Protein in the urine (proteinuria) is the strongest predictor of IgAN progression. Persistent protein in your urine signals inflammation and kidney stress.
A sustained drop in protein is one of the clearest signs that treatment is working, and lower protein levels are linked to better long-term outcomes. Today, most treatment plans aim to keep protein loss below 0.5 grams per day—and ideally under 0.3 grams per day.
Providers measure protein in your urine with tests like the urine albumin-to-creatinine ratio (uACR). A result of 30 mg/g or higher lasting three months or more signals kidney damage.
2. Blood in the Urine
Blood in your urine (hematuria) shows that inflammation is active in your kidneys. You may see it as pink or tea-colored urine, or it may only appear on lab tests.
A single episode after an infection or sore throat is common and not always concerning. However, persistent hematuria raises concerns, and reductions in hematuria often signal that inflammation is improving.
3. Worsened Kidney Function
The estimated glomerular filtration rate (eGFR) is a blood test that shows how well your kidneys filter waste by measuring creatinine, a waste product. Providers focus on keeping eGFR stable over time, with minimal yearly decline.
A lower eGFR at diagnosis is associated with faster progression. An eGFR below 60 for at least three months suggests chronic kidney disease.
4. High Blood Pressure
High blood pressure damages your kidneys’ blood vessels and speeds disease progression. Tight blood pressure control helps slow kidney damage. Providers typically recommend keeping blood pressure below 130/80 but often want people with IgAN to keep it below 120/70.
5. Kidney Scarring
A kidney biopsy can confirm IgAN and show the extent of scarring and inflammation. More scarring usually means higher progression risk.
Your provider looks at your risk factors, lab results, clinical findings, and how well you respond to current treatments to guide care. Some treatments for IgAN come from blood pressure or diabetes care, while newer medications target IgAN more directly.
- Blood pressure medications: Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are typically a part of IgAN treatment. These reduce stress on your glomeruli, which helps lower the amount of protein in your urine.
- Immune-targeted therapies: Your provider may prescribe immune-calming medications like Tarpeyo (budesonide), Medrol (methylprednisolone), and Fabhalta (iptacopan).
- Endothelin receptor antagonists (ERAs): ERAs like Vanrafia (atrasentan) and Filspari (sparsentan) relax blood vessels in your kidneys. This lowers proteinuria. Filspari (sparsentan) also works as an ARB, so you should not take it with ACE inhibitors or other ARBs.
- SGLT2 inhibitors: Jardiance (empagliflozin) and Farxiga (dapagliflozin) are diabetes medications that can also protect your kidneys by reducing proteinuria, even if you don’t have diabetes.
- Emerging therapies and clinical trials: Voyxact (sibeprenlimab) is a newer injection given every four weeks. It works early in the process by targeting the APRIL protein, which helps reduce abnormal IgA buildup. To explore current studies, search ClinicalTrials.gov by trial location and eligibility.
If you’re at higher risk, ask your provider about kidney function screening. If you have IgA nephropathy:
- See your provider for blood and urine tests every three to six months.
- Monitor your home blood pressure readings.
- Contact your provider if you notice pink, red, or cola-colored urine.
