Your Guide to Medications for IgA Nephropathy and C3G

When your kidneys aren’t functioning as well as they used to due to IgA nephropathy (IgAN) or complement 3 glomerulopathy (C3G), the effects can echo throughout your body. A change in your medication regimen — more of some, fewer of others — can help restore balance.

Nephrologist Corey Cavanaugh, DO, shares what you can (and can’t) expect to find in your medicine cabinet after an IgAN or C3G diagnosis.

What your doctor may recommend

The medications your provider suggests for keeping your whole body healthy when you’re living with IgAN or C3G depend on how severe your condition is and the symptoms you’re experiencing.

The goal? Ensuring your body gets what it needs while keeping side effects to a minimum.

“Your kidneys do a lot of great things, so when they’re not functioning as well as they should, your provider will probably look to supplement some of that function with medication,” Dr. Cavanaugh says.

Depending on your symptoms and your disease progression, he adds that your provider may suggest medications to help perform some of your kidneys’ essential functions.

Medications can do things like:

Control acid buildup

Our bodies (and the food we eat) naturally produce acid. One of your kidneys’ jobs is to help clear that acid. When your kidneys aren’t working well, the acid builds up in your body, a condition called metabolic acidosis.

That extra acid can cause symptoms like fatigue, confusion, loss of appetite and more. Over time, the excess acid can wear away at your bones, causing renal osteodystrophy, a condition associated with bone pain and fractures.

As you may have learned in chemistry class, bases neutralize acids. So, your provider may recommend a base, like sodium bicarbonate or sodium citrate, to reduce the acid buildup and protect your bones.

Manage anemia

If you have IgA nephropathy or C3G, your provider may recommend synthetic erythropoietin therapy or iron supplements to reduce your risk of anemia (a low number of healthy red blood cells).

“Your kidneys make a hormone called erythropoietin, which tells your bones to make red blood cells,” Dr. Cavanaugh explains. “When you have kidney disease, you may not make enough erythropoietin, or you may be less sensitive to it, which leads to anemia.”

Classic symptoms of anemia include:

• Feeling tired, weak or like you might faint
• Shortness of breath
• Headaches
• Pale skin
• Sweatiness, dizziness or lightheadedness

Keep blood pressure in check

Your provider may prescribe medication to lower your blood pressure. That’s important because high blood pressure can both cause and be caused by kidney diseases like IgAN and C3G.

Your kidneys are responsible for filtering sodium from your body. When you have kidney disease, sodium builds up. It raises your blood pressure, which can lead to heart attack, stroke, eye damage and more.

Common blood pressure medications include:

• Angiotensin-converting enzyme inhibitors (ACE inhibitors)
• Angiotensin II receptor blockers (ARBs)
• Thiazides or loop diuretics (“water pills”)
• Calcium channel blockers (CCBs)

Remove protein from urine

Some medications, called renin-angiotensin system (RAS) inhibitors, may be used to treat high blood pressure and protein in the urine (proteinuria), a classic finding in both IgA nephropathy and C3G.

“RAS inhibitors are some of our first-line medications for treating both high blood pressure and proteinuria,” Dr. Cavanaugh notes.

A class of medications originally intended to treat people with diabetes is also gaining traction for use in people with kidney disease. They’re called SGLT2 inhibitors, and they go by names like:

• Canagliflozin (Invokana®)
• Dapagliflozin (Farxiga®)
• Empagliflozin (Jardiance®)

“Aside from reducing protein in the urine, they protect your kidneys by decreasing the pressure in the nephron, which is where the blood filtration process starts,” he adds.

Suppress immune response

IgA nephropathy and C3G are both autoimmune diseases, so your provider may prescribe immunosuppressants to improve your kidney function.

If you think of your immune system like a pot of water on the stove, it’s generally set to a simmer. When you have an infection, your immune system turns up the heat to defend against the threat. When the infection clears, it returns to a slow boil.

When you have an autoimmune disorder, the burner is stuck on high heat. Your immune system is creating loads of IgA protein to fight off bacteria and viruses. But there aren’t any germs to fight off. So, that IgA builds up in your kidneys.

Dr. Cavanaugh says providers may prescribe immunosuppressant medications — typically, steroids like prednisone — to turn down the heat on your burner. Steroids reduce your immune response, giving your kidneys a chance to do their work without being overloaded with IgA.

“In the short term, steroids can help inflammation and calm things down,” he continues. “But prolonged use can cause some pretty serious side effects that we try to avoid.”

Among the side effects associated with steroids are:

• A lowered ability to fight infections
• Bone loss
• Cataracts
• Diabetes
• Insomnia
• Poor wound healing
• Weight gain

Some newer steroids attempt to suppress immune system response with fewer side effects.

Medications to avoid or limit

In addition to taking new medications, your provider will likely counsel you to eliminate or avoid other medications to protect your kidney function.

NSAIDs

When you’re living with IgA nephropathy, C3G or other kidney diseases, you should avoid nonsteroidal anti-inflammatory medications (NSAIDs) entirely, as they can damage even healthy kidneys.

Common NSAIDs include:

• Ibuprofen (known by brand names such as Motrin® and Advil®)
• Naproxen sodium (known by the brand name Aleve®)
• Aspirin

Certain heartburn meds

Medications called proton-pump inhibitors that are used to treat ulcers and heartburn may be too risky when you have IgA nephropathy, C3G or another kidney disease.

Common proton-pump inhibitors include medications that end in “-ole” like:

• Esomeprazole (Nexium®)
• Lansoprazole (Prevacid®)
• Omeprazole (Prilosec®)
• Pantoprazole (Protonix®)
• Rabeprazole (AcipHex®)

IV contrast

If you’re going to have a medical procedure like a CT scan, cardiac catheterization or another test that uses IV contrast dye, make sure your provider knows you have kidney disease. They may need to adjust the type or amount of dye you receive or have other instructions for you to follow related to your procedure.

Final thoughts

Medication needs may differ from person to person based on the kidney disease you have and how it impacts your body and your life. Your provider will monitor you closely and discuss strategies and options.