The IgAN Post-Infection Flare: Your Step-by-Step Action Plan

IgAN flares usually occur within one to three days after infection symptoms begin, which is why they seem to be closely linked to a cold or flu, says Dr. Diaz. Many flares improve on their own, but they’re still a sign that the kidneys are under stress and should be taken seriously, she says.

If you notice blood in your urine, early action can protect your kidneys and give your healthcare team the information they need to manage your care. Here’s what to do during the first 24 hours.

Step 1: Notify Your Nephrology Team Immediately

Don’t ignore it, says Diaz. Call your nephrologist as soon as you notice a change in urine color, especially if this is the first time it’s happened or if the flare feels more severe than previous ones, she says. Reporting this early allows your medical team to determine if you need to be seen in person and if additional testing is needed.

Step 2: Stay Calm

It’s natural to feel distressed, but try to remember that visible blood in the urine during or shortly after an infection is not unusual in IgAN, says Diaz.

Step 3: Hydrate Generously (Unless Your Provider Has Told You Otherwise)

Drinking plenty of fluids helps flush red blood cells through the kidneys’ filtering tubes, which can prevent blockages that might cause further kidney injury, says Dr. Zhdanova. But if you’ve been given fluid limits because of other health issues, follow your provider’s guidance, says Diaz.

Step 4: Avoid Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Step 5: Monitor Your Blood Pressure

“A flare can cause a sudden spike in blood pressure. If it’s significantly higher than your baseline, it indicates the kidneys are under acute stress and need medical intervention,” says Zhdanova. If you have a home blood pressure monitor, take a reading and write down the number and the time. If you don’t, many pharmacies, clinics, and urgent care centers offer blood pressure checks. Keep a log of these readings to share with your care team.

Step 6: Document Your Symptoms

Diaz recommends noting the color of your urine, when you first noticed the change, and if you see any blood clots. You should also pay attention to how much you’re urinating. If you’re making significantly less urine despite drinking plenty of fluids, it could indicate acute kidney injury (AKI), which is a sudden drop in kidney function, says Zhdanova, and you should notify your care team right away.

Let your nephrologist know about other symptoms, such as fever, discomfort on your side or back, sudden weight gain, fatigue, or swelling in your ankles, hands, or face. This information helps your team determine the best treatment course.

When to Seek Emergency Care

Most IgAN flares can be managed at home with guidance from your nephrology team, but some symptoms need immediate medical attention. Diaz recommends getting emergency care right away if you experience:

• Very little urination or no urination at all
• Severe back or abdominal pain
• Large blood clots in your urine
• Shortness of breath
• Chest pain
• Rapid swelling in your face, legs, or around your eyes
• Blood pressure readings that are higher than your normal range
• Nausea and vomiting

“These symptoms may indicate acute kidney injury, fluid overload, or other serious complications requiring immediate attention and treatment,” says Diaz.

Once you’re at the clinic, your medical team will generally check your kidney function and determine how to best manage the flare. Your provider may order one or more of the following tests, says Diaz:

• Urinalysis: This is a basic test that checks for several markers in your urine.

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  A urinalysis can help confirm the presence of blood in the urine, give an initial look at urine protein levels, and check for signs of infection.

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• Urine protein-to-creatinine ratio (uPCR): While a urinalysis can detect whether protein is present, a uPCR test measures how much protein you’re losing in your urine (proteinuria).

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   Your nephrologist will usually compare the current uPCR number with your past results to see if proteinuria levels are higher than before.
• Basic metabolic panel: This blood test shows how well your kidneys are working. It looks at creatinine and your estimated glomerular filtration rate (eGFR) to see if kidney function has dropped.

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   It also checks electrolyte levels, which can be affected when kidney function changes, says Diaz.
• Blood pressure measurements: Your care team will check your blood pressure and adjust medications if needed to help protect your kidneys.

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• Kidney ultrasound: In some cases, your nephrologist may order an ultrasound to look for any structural changes in your kidneys.

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• Cultures or infection testing: If there’s concern about an ongoing infection, your care team may run additional tests to ensure the source is being treated correctly.

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In more severe cases, your nephrologist may consider a kidney biopsy and, in select situations, immunosuppressive therapy like steroids to reduce inflammation, says Diaz. But this approach is individualized and not routine for every flare.

Visible blood in the urine generally clears within the first few days, often within 72 hours as the infection improves, says Zhdanova, though timing varies from person to person. Microscopic hematuria and elevated protein levels in the urine may linger for a week or two, but should start trending downward, she adds.

If your kidney function (eGFR) hasn’t improved by three weeks after the flare, your nephrologist will likely do a more thorough evaluation, says Zhdanova. This might include repeating a kidney biopsy to determine what’s causing the decline. If the biopsy confirms increased IgA disease activity, your healthcare team will generally ensure you’re on a comprehensive medication regimen that includes angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), sodium-glucose cotransport 2 (SGLT2) inhibitors, and cholesterol-lowering medications to protect your kidneys, she says. Depending on your situation, specific IgA treatments may also be needed, and there are several new FDA-approved medications available for treating IgA nephropathy, she says.

That said, recurrent or severe IgAN flares that don’t resolve quickly can lead to permanent kidney damage, which is why taking action early is so important.

It’s important to have an action plan for an IgAN infection flare, but the goal is to prevent them. When illness does happen, flares are often less severe and recovery smoother if your kidneys are already functioning as well as they can. This starts with managing key risk factors, like blood pressure and proteinuria, to help protect your kidneys during future infections, says Diaz.

Here’s what you can do to help prevent future flares.

• Stay up-to-date on vaccinations. Get your annual flu shot, COVID-19 vaccines, and pneumonia vaccines as recommended by your healthcare providers.

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   These can prevent the types of infections that commonly trigger flares. Some people with IgAN may experience a flare after getting COVID-19 vaccines, but research shows these are typically temporary and don’t lead to long-term kidney damage.

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   The benefits of vaccination in preventing serious COVID-19 infection generally outweigh this risk.

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   Talk with your nephrologist if you have questions about vaccine timing.
• Practice good hand hygiene and infection prevention. Wash your hands frequently, and if you can, avoid close contact with people who are sick.

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• Keep your blood pressure under control. High blood pressure puts extra strain on your kidneys. If you’ve been prescribed blood-pressure-lowering medications, take them consistently.

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   These medications can also help manage proteinuria.
• Get routine monitoring. Stay on top of your scheduled lab tests and medical appointments to help catch changes early and adjust treatment as needed.
• Follow a kidney-friendly lifestyle. Habits like eating a low-sodium diet, staying well-hydrated, avoiding smoking, and getting regular exercise can help your kidneys work more efficiently.

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• Avoid kidney-harming medications. These usually include NSAIDs and certain antibiotics, unless your nephrologist approves them.

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• Treat infections promptly. If you do get sick, don’t wait it out. Contact your healthcare provider early to start any necessary treatment right away.

These steps may reduce both the frequency of flares and your long-term kidney risk, says Diaz.

• If you have IgA nephropathy (IgAN), dark or cola-colored urine (blood in the urine) during or shortly after an infection can occur, and it’s known as an IgAN infection flare. Report it right away to your nephrology team.
• Stay well-hydrated unless told otherwise, avoid nonsteroidal anti-inflammatory drugs (NSAIDs), and monitor your blood pressure. Seek emergency care immediately if you have little to no urination, chest pain, shortness of breath, or rapid swelling.
• Visible blood in the urine often resolves within days, and kidney function typically improves gradually, though recovery may take weeks or longer.
• Severe or repeated IgAN infection flares can cause lasting kidney damage, which is why preventing infections and controlling blood pressure and proteinuria are important.