Diarrhea — loose or watery stool — is a common problem that most people experience once or twice a year. If you’re living with a kidney disease like immunoglobulin A nephropathy (IgAN), you may have to take extra precautions when you have diarrhea. While diarrhea isn’t a symptom of IgAN, it can complicate the condition by worsening your kidney function.

Continue reading to find out what you should know about diarrhea if you’re living with IgAN.

1. Diarrhea Can Make Kidney Disease Worse

Diarrhea can lead to complications that can worsen kidney disease. In severe cases, diarrhea can cause you to become dehydrated and disrupt the balance of electrolytes (essential minerals) in your body. Dehydration can decrease blood flow to your kidneys and cause sudden or acute kidney injury (AKI), also called acute renal failure or kidney failure.

A study found that 1 out of 10 adults hospitalized for diarrhea develop AKI. If you have AKI, your kidneys aren’t able to filter waste products from your blood, which then build up in your blood, causing serious problems.

If you have IgAN, you may have a higher risk for dehydration and AKI if you have proteinuria (protein in your urine) or reduced kidney function or you use medications like ACE inhibitors or angiotensin-receptor blockers (ARBs).

Possible signs and symptoms of acute kidney injury include:

• Too little urination
• Fatigue (extreme tiredness that doesn’t improve with rest)
• Edema (swelling from fluid buildup), especially in the feet and ankles
• Confusion

AKI can lead to permanent kidney damage, which may worsen kidney disease. People with chronic kidney disease (CKD) and hypertension (high blood pressure) may be more susceptible to developing AKI when they have diarrhea.

Although it’s possible to get AKI from any kind of diarrhea, it’s most likely when you have diarrhea caused by an infection.

2. People With Kidney Disease May Have an Increased Risk of Diarrhea

IgAN can affect your digestive tract, where it causes low-grade inflammation. Even though constipation is usually the most common digestive problem associated with kidney disease, diarrhea is common for many people living with IgAN.

A study published in BMC Nephrology showed that people with IgAN experienced higher rates of diarrhea than people without the disease, especially those who were female. There are several reasons people with kidney disease may have an increased risk of developing diarrhea.

Weakened Immune System

People with kidney disease can have a weakened immune system that makes them more likely to develop an infection. The higher risk of infection is due to several factors, including:

• Immunosuppressive therapy — Drugs that weaken the immune system are used to treat IgAN or to prevent a kidney transplant rejection.
• Other medical conditions — Conditions such as diabetes or autoimmune conditions can increase infection risk.
• Malnutrition — If they don’t eat enough protein, people with IgAN might develop malnutrition, which increases the risk of infection.

Antibiotic Use

If you have a weakened immune system due to kidney disease, you may also be more likely to need antibiotics to help fight off bacterial infections. Many antibiotics can cause diarrhea because they disrupt the balance of good and bad bacteria in your gut.

Some antibiotics are more likely to cause diarrhea than others. The antibiotics that are most commonly associated with diarrhea include:

• Cephalosporins
• Fluoroquinolones
• Penicillins

You may be more likely to get diarrhea from antibiotics if you’re also taking immunosuppressive medications for IgAN or if you’ve had diarrhea from an antibiotic in the past. Talk to your doctor about the risk of diarrhea from any new antibiotic you’re taking.

Other Medications

Medications other than antibiotics can cause diarrhea, including:

• ACE inhibitors and ARBs
• Proton pump inhibitors (PPIs) for heartburn, such as esomeprazole, omeprazole, and pantoprazole
• Immunosuppressant medications, such as mycophenolate
• Antidepressants, such as escitalopram, fluoxetine, and sertraline

People with IgAN may be more likely to take some of these medications, like PPIs, that can cause diarrhea and increase the risk of C. difficile colon infection.

You might take mycophenolate for IgAN or to treat kidney disease caused by an autoimmune condition, such as lupus.

You may take an antidepressant if you also have depression, which is more common in people with kidney disease than in the general population.

Talk to your nephrologist about the possible side effects, like diarrhea, of the medications you take and how they may affect your kidneys.

3. You May Need To Avoid Certain Diarrhea Treatments With Kidney Disease

If you have diarrhea, you might be tempted to reach for an over-the-counter (OTC) or at-home remedy. However, some of these treatment options can be dangerous for people with kidney disease. This is especially true for medications that contain electrolytes.

Check with your nephrologist or dietitian before using any at-home treatments for diarrhea.

Magnesium Hydroxide

Magnesium hydroxide (milk of magnesia) is an example of a medication that you should be wary of if you have kidney disease. This OTC medication can be used to treat upset stomach, heartburn, and constipation. You may be tempted to take this medication if you have diarrhea and an upset stomach. However, magnesium can disrupt your electrolyte balance and cause kidney damage.

Rehydration Therapy

Recommended home remedies to treat diarrhea often include rehydration therapy with fluids containing electrolytes and glucose (sugar), such as:

• Broth
• Soft drinks without caffeine
• Fruit juice
• Sports drinks like Gatorade

However, if you have IgAN, you may have restrictions on how much fluid, sodium, and potassium you can have each day. It’s important to check with your nephrologist or dietitian before adding these to your diet.

Diet

When you have diarrhea, it’s generally better to stay away from greasy or fatty foods and stick with foods that are easier to digest. Healthcare providers sometimes recommend the BRAT diet, with “BRAT” standing for “bananas, rice, applesauce, toast.”

However, if you have kidney disease, you may need to avoid bananas, which are rich in potassium. You should also be mindful of the salt and electrolyte content of any rehydration therapy you use.

Talk to your doctor about the best foods to eat when you have diarrhea, especially if you’re on a renal diet.

4. Diarrhea Can Have Various Causes

If you’re living with kidney disease, it’s important to take steps to prevent diarrhea. Although the cause of a bout diarrhea is often unknown, you should be aware of the most common causes. These include:

• Bacterial infections and antibiotics
• Foods that upset your digestive tract
• Food allergies or intolerances
• Trouble absorbing food
• Laxatives
• Medications for IgAN, like mycophenolate, ACE inhibitors, and ARBs

Steps you can take to prevent diarrhea include:

• Washing your hands often with soap and water
• Washing fresh fruits and vegetables before eating them
• Avoiding raw or undercooked meats
• Storing food properly
• Being cautious about drinking tap water when you travel

What Should You Do if You Have Diarrhea?

Contact your doctor right away if you have any of the following symptoms, which could be red flags:

• Diarrhea lasting more than two days
• New swelling with diarrhea
• Urinating less often
• Dizziness

If you have diarrhea while living with IgAN, it’s important to talk to your doctor or nephrologist about the best treatment options for you.

Join the Conversation

On myIgANteam, people share their experiences with IgA nephropathy, get advice, and find support from others who understand.

How have you managed diarrhea with IgA nephropathy? Let others know in the comments below.