When immunoglobulin A nephropathy (IgA nephropathy) damages your kidneys, it can cause a chain reaction of changes that affect how your body works. Just like other forms of chronic kidney disease (CKD), IgA nephropathy can cause anemia (low red blood cells). Your red blood cells deliver oxygen from your lungs to the rest of your body. Your body relies on this process for energy in order to function properly.

Research suggests that anemia in people with IgA nephropathy, in turn, can worsen the progression to end-stage kidney disease, which is why it’s crucial for you and your doctor to track your hemoglobin levels. Hemoglobin is an iron-rich protein inside healthy red blood cells that helps to carry oxygen. Low hemoglobin levels can indicate anemia. Having low levels of red blood cells suggests that your body doesn’t have enough hemoglobin and may not be getting enough oxygen.

How IgA Nephropathy Leads to Anemia

To understand how IgA nephropathy causes anemia, you must first understand how and where your body makes red blood cells. This process, called erythropoiesis, happens in your bone marrow — the spongy tissue inside many of your bones.

Erythropoiesis happens in response to a hormone from your kidneys, called erythropoietin. Your kidneys secrete this hormone in a small amount to replace the old, worn-out red blood cells. However, when your oxygen levels are low, the kidneys sense it and secrete more of this hormone. This tells certain cells in the bone marrow to mature into red blood cells. Once mature, your bone marrow releases them into your bloodstream so that they can carry a normal amount of oxygen to your tissues.

When inflammation in IgA nephropathy damages your kidneys, your kidneys no longer make enough erythropoietin to keep up with demand. Some people with kidney disease are also less sensitive to erythropoietin, leading to a shortage of red blood cells.

Recognizing Signs of Anemia in IgA Nephropathy

Symptoms of anemia are widely recognizable, but they can overlap with symptoms of other conditions, including IgA nephropathy itself. IgA nephropathy may not cause any symptoms until later stages, but you might eventually feel weak and tired. These are also common signs of anemia.

Anemia doesn’t always cause symptoms, but it may cause the following in people with kidney disease:

• Dizziness or lightheadedness
• Headache
• Pale skin
• Racing heartbeat
• Shortness of breath
• Low or depressed mood
• Sweating
• Fatigue and trouble sleeping
• Brain fog
• Low appetite

Certain symptoms of anemia can also be a sign that your IgA nephropathy has progressed to kidney failure. Go to the emergency room right away if you have IgA nephropathy and experience any of the following symptoms:

• Sudden increase in tiredness
• Increased or decreased urination frequency
• Trouble concentrating
• Insomnia
• No appetite

Certain symptoms of anemia, like fatigue, brain fog, and decreased appetite can also be signs that your IgA nephropathy has progressed to kidney failure.

Who Gets Anemia With IgA Nephropathy?

You’re more likely to develop anemia as your kidney disease progresses. Around 8.4 percent of people with stage 1 kidney disease have anemia compared to over 53 percent of people with stage 5 kidney disease.

Although most people with kidney disease will eventually develop anemia, some have a higher risk than others, according to the National Kidney Foundation:

• People with diabetes
• Females
• African American/Black people
• People of older ages
• People in the later stages of kidney disease or with a significant loss of kidney function

You’re more likely to develop anemia as your kidney disease progresses.

How Anemia Is Diagnosed

Whether or not anemia causes symptoms, the only way to confirm if you have anemia is with a complete blood count (CBC) that checks all your blood cells, including red blood cells and hemoglobin. Most nephrologists (kidney doctors) recommend getting a hemoglobin blood test at least once a year if you have kidney disease.

Hemoglobin blood tests measure how much hemoglobin is in your blood. Hemoglobin is a protein in red blood cells that carries oxygen throughout your body.

Healthy amounts of hemoglobin are different for men and women, according to StatPearls. Normal ranges for men are 13.5 grams per deciliter (g/dL) to 17.5 g/dL, while a healthy range for women is 12.0 g/dL to 15.5 g/dL.

For men, 13.5 g/dL or lower indicates low hemoglobin. For women, low hemoglobin is 12 g/dL or lower. These numbers suggest you have anemia, which may stem from your IgA nephropathy or another cause. Your doctor might use additional tests to rule out other possible causes of anemia or low hemoglobin, like nutrient deficiencies.

Treating Anemia With IgA Nephropathy

Anemia with IgA nephropathy is linked to poorer IgA nephropathy outcomes and faster kidney disease progression, so treating your anemia is an important part of managing IgA nephropathy as a whole.

Anemia with IgA nephropathy is linked to poorer IgA nephropathy outcomes and faster kidney disease progression, so treating your anemia is an important part of managing IgA nephropathy.

Anemia treatment can differ based on what’s causing your anemia. If your healthcare provider determines that your anemia is linked to your IgA nephropathy, they may recommend one or more of the following treatments to increase your hemoglobin levels.

Erythropoiesis-Stimulating Agents

Erythropoiesis-stimulating agents (ESAs) are medications that help your bone marrow make more red blood cells when it’s having trouble making them on its own. Delivered as an injection, ESAs are synthetic (human-made) erythropoietin.

Iron Supplements

Your body relies on iron to produce red blood cells. It’s especially important to take iron supplements if you’ve been prescribed ESAs. There are a few ways to take iron supplements. While many people take them as pills or capsules, you can also get iron intravenously (through a vein) in some doctors’ offices. Your doctor will suggest the most appropriate approaches for you depending on how low your hemoglobin levels are.

Your doctor or nephrologist might also suggest getting more iron in your diet by eating foods like leafy greens (think kale and spinach) or beans and lentils. Talk to your doctor or dietitian about which iron-rich foods you can safely eat as part of your kidney-friendly eating plan, making sure you get the right amounts of nutrients like sodium and potassium.

If You’re on Dialysis

Your anemia may be more severe if you’re on dialysis for end-stage kidney disease because of blood loss during dialysis. You might also need to avoid foods that normally supply you with a lot of iron while on dialysis, such as beans and red meat.

Although treating your anemia won’t reverse your kidney failure, it can give you more energy, improve your ability to exercise, and reduce your risk of heart complications. If you’re on dialysis, your nephrologist will likely treat your anemia with a combination of ESAs and iron supplements. You won’t be able to get enough iron through your diet to meet your body’s needs.

To make sure you’re getting the right amount of iron while on dialysis, your healthcare provider will regularly check your hemoglobin levels. They also measure your transferrin saturation (TSAT) and ferritin. These are two lab tests that can tell you more about your body’s iron levels.

Talk to Your Doctor

If you have IgA nephropathy, it’s important to stay in touch with your nephrologist and get regular hemoglobin tests. Although anemia might not cause symptoms, let your doctor know right away if you experience any of the common signs of anemia. They can determine if you have anemia related to CKD and recommend treatment based on your needs.

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