Seeing blood in your urine – often a dark, tea- or cola-color – can be frightening, especially if you live with immunoglobulin A (IgA) nephropathy (IgAN). This condition causes inflammation in the kidneys due to deposits of IgA antibodies. These episodes, called IgAN flares, typically happen after an illness like a cold or flu. While alarming, knowing how to respond quickly can protect your kidneys and limit damage.
Understanding IgAN Flares and Hematuria
The visible blood in urine is called macroscopic hematuria, distinct from microscopic hematuria detectable only in lab tests. In IgAN, flares occur because illness activates the immune system, increasing IgA production. Abnormally formed IgA then gets trapped in the kidneys, causing inflammation and blood leakage into the urine. The color changes to reddish, tea-colored, or cola-colored as blood breaks down. Flares usually appear one to three days after an infection starts and often resolve on their own, but should always be taken seriously.
Your 24-Hour Action Plan
If you notice blood in your urine, immediate action is critical. Here’s what to do:
- Contact Your Nephrologist: Don’t wait. Call your kidney specialist right away, especially if this is new or more severe than previous flares. Early reporting allows for timely assessment and testing.
- Stay Calm: While distressing, visible blood isn’t unusual during or after an infection in IgAN. Panicking won’t help.
- Hydrate Aggressively (Unless Restricted): Drinking plenty of fluids helps flush red blood cells, preventing blockages. Follow your doctor’s fluid guidelines if you have other health conditions.
- Avoid NSAIDs: Nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen reduce blood flow to inflamed kidneys, worsening the flare. Use acetaminophen instead, or ask your doctor for a safe alternative.
- Monitor Blood Pressure: Flares can cause sudden spikes. Check your blood pressure at home if possible, and note readings to share with your team. High blood pressure indicates acute kidney stress.
- Document Symptoms: Record urine color, timing of changes, and any blood clots. Also, track urine output. Significantly reduced urine despite drinking fluids suggests acute kidney injury, requiring immediate medical attention. Note fever, flank pain, weight gain, or swelling.
When to Seek Emergency Care
Most IgAN flares are manageable at home with medical guidance. However, certain symptoms demand immediate attention:
- Very little or no urination
- Severe back or abdominal pain
- Large blood clots in urine
- Shortness of breath or chest pain
- Rapid swelling in the face, legs, or around the eyes
- Dangerously high blood pressure
- Nausea and vomiting
These signs indicate acute kidney injury, fluid overload, or other serious complications.
What to Expect at the Doctor’s Office
Your medical team will assess kidney function and determine the best course of action. Common tests include:
- Urinalysis: Confirms blood presence and checks for protein.
- Urine Protein-to-Creatinine Ratio (uPCR): Measures protein loss, comparing to previous results.
- Basic Metabolic Panel: Evaluates kidney function (creatinine, eGFR) and electrolytes.
- Blood Pressure Check: Adjusts medications if needed.
- Kidney Ultrasound: Checks for structural changes.
- Cultures/Infection Testing: Rules out ongoing infection.
Treatment typically involves managing blood pressure, staying hydrated, and avoiding kidney-damaging drugs. Antibiotics may be prescribed for active infections. In severe cases, a kidney biopsy or immunosuppressive therapy (steroids) may be considered.
Long-Term Outlook and Prevention
Visible blood usually clears within 72 hours as infection subsides, though microscopic hematuria and protein levels may linger for weeks. Kidney function may temporarily worsen before improving, but recovery can take longer after severe flares. Recurring or poorly managed flares can cause permanent damage.
Preventing flares involves:
- Vaccinations: Stay current on flu, COVID-19, and pneumonia shots.
- Hygiene: Practice good handwashing.
- Blood Pressure Control: Adhere to prescribed medications.
- Routine Monitoring: Follow scheduled lab tests and appointments.
- Lifestyle: Eat a low-sodium diet, stay hydrated, avoid smoking, and exercise.
- Medication Avoidance: Skip NSAIDs unless approved by your doctor.
- Prompt Infection Treatment: See a doctor early when sick.
Ultimately, IgAN flares are manageable when addressed promptly. By taking these steps, you can protect your kidneys and improve long-term health.
