Why Managing Blood Pressure With IgA Nephropathy Is Your Best Defense Against Dialysis
Published on June 30, 2026
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After an IgA nephropathy (IgAN) diagnosis, your care team has likely discussed different treatment options with you, including some newer targeted therapies such as targeted-release budesonide or atrasentan (Vanrafia). Chances are they’ve also emphasized the importance of keeping your blood pressure under control.
With IgAN, the damage that occurs in the kidneys’ filters can lead to high blood pressure. “In turn, high blood pressure can further damage the filters and the kidney,” says Raven Voora, MD, a professor of medicine and the associate program director of nephrology and hypertension training program at the University of North Carolina School of Medicine in Chapel Hill, North Carolina.
That makes blood pressure management one of the most effective ways to preserve kidney function and delay the need for dialysis.
How High Blood Pressure Accelerates IgAN
To understand why blood pressure management matters so much with IgAN, it’s helpful to examine what happens inside the kidneys.
Kidney Damage Can Raise Blood Pressure
The kidneys contain tiny filtering units called glomeruli. Dr. Voora suggests thinking of glomeruli as microscopic mesh filters. These filters remove waste and excess fluid from your blood while keeping important substances, such as protein, from leaking out.
In IgAN, the body makes an abnormal form of immunoglobulin A (IgA), a protein that’s normally part of your immune defense. The immune system sees this abnormal IgA as a threat and creates antibodies to attack it, says Yasir Qazi, MD, a transplant nephrologist with Providence St. Joseph Hospital in Orange, California.
These antibodies attach to the abnormal IgA and create clumps that can become trapped in the kidney’s mesh filters, triggering inflammation and damage. As the damage progresses, the filters become less effective at removing excess fluid and sodium from the body, which can lead to high blood pressure.
At the same time, higher blood pressure means blood is pushing through the kidneys’ filters with greater force. Voora compares that force to a power washer hitting a delicate mesh screen. The added pressure can tear and damage the filters even further, increasing kidney damage, she says.
High Blood Pressure Can Cause Excess Protein in Urine
With high blood pressure, the specialized cells that support the glomeruli can also become damaged, Voora says. The walls of the tiny blood vessels inside the glomeruli can stretch and weaken as well. As a result, large protein molecules that normally belong in the bloodstream can leak into the urine, a condition known as proteinuria.
Proteinuria is a sign that the kidney filters are damaged. As the kidneys try to process and reabsorb protein leakage, more inflammation can develop, adding to the injury already caused by IgAN.
“High levels of protein leakage are the strongest indicator that the disease is active, the kidneys are under stress, and there is a higher risk of progression toward dialysis, if not addressed,” says Voora.
Kidney Scarring Can Occur
When the kidneys face continued stress from high blood pressure and inflammation, they try to repair the damage. One way they do this is by laying down scar tissue.
The problem is that once a filtering unit becomes scarred, known as glomerulosclerosis, it loses its blood supply and can no longer function properly, says Voora.
As more scarring occurs, the remaining healthy filters have to take over the workload. “To compensate, these healthy filters dilate and experience even higher blood pressure and filtration demands, leading to burnout and faster scarring,” Voora explains.
Meanwhile, the kidneys can also trigger the release of hormones that tighten blood vessels, which also raises blood pressure. Dr. Qazi says that this creates a cycle in which high blood pressure causes kidney scarring, and kidney scarring causes blood pressure to rise.
Breaking that cycle is one of the main goals of IgAN treatment.
Your Blood Pressure Target
When you have IgAN, it’s best for your blood pressure to be as low as you can tolerate without having symptoms of low blood pressure, says Qazi. These include dizziness, lightheadedness, weakness, or feeling like you might faint.
The general blood pressure target for IgAN is 120/70 mmHg or lower. Systolic is the top number in a blood pressure reading; it measures the pressure inside your arteries when your heart contracts. The bottom number is diastolic, a measure of the pressure when your heart relaxes.
Keeping the systolic pressure low minimizes the “power washer” effect, Voora says, and can protect the remaining healthy filters in the kidneys from more stress and further damage.
If you’re monitoring your blood pressure at home, ask your nephrology team what range is recommended for you. The goals can vary based on your age, kidney function, and whether you have significant proteinuria. Notify your care team if your blood pressure readings are consistently higher than your target or if you develop symptoms of low blood pressure.
How to Control Blood Pressure
So how can you help get your blood pressure into that target range, and keep it there? For most people with IgAN, it involves a combination of medication and lifestyle adjustments.
Common Blood Pressure Medications for IgAN
When choosing blood pressure medications for IgAN, your care team usually looks for options that do double duty, meaning they lower your overall blood pressure while also reducing the pressure inside the kidney’s filters, says Voora.
Classes of medications commonly used include:
- Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARBs) These medications, which include lisinopril (Zestril, Prinivil) and losartan (Cozaar), are the foundation of treatment for IgAN, Voora says. In addition to lowering blood pressure, they reduce pressure inside the kidney filters, which can lower proteinuria and slow kidney scarring.
- Mineralocorticoid Antagonists These medications, such as spironolactone (Aldactone), block the effects of aldosterone, a hormone that can contribute to inflammation and scarring in the kidneys, Voora says. They may be added to an ACE inhibitor or ARB for additional kidney protection.
- Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors Originally developed to help manage diabetes, SGLT2 inhibitors, such as dapagliflozin (Farxiga) and empagliflozin (Jardiance), may slow the loss of kidney function and reduce proteinuria in people with IgAN when added to standard treatment.
Other medications that target some of the underlying processes that contribute to kidney damage in IgAN have become available in recent years. These include:
- targeted-release budesonide (Tarpeyo)
- sparsentan (Filspari)
- atrasentan (Vanrafia)
- iptacopan (Fabhalta)
- sibeprenlimab (Voyxact)
Your nephrologist can help you understand whether any of these treatments may be appropriate for you.
Lifestyle Changes
When combined with medication, adjustments to your lifestyle can lower your blood pressure and ease the load on your kidneys. Here’s what experts recommend.
- Watch your sodium intake. This is one of the biggest dietary changes recommended for people with IgAN. Too much sodium can raise blood pressure and reduce the effectiveness of blood pressure medications, says Voora, who recommends keeping your sodium intake to less than 2,000 milligrams (mg) per day. Strategies for an IgAN diet that’s low in sodium include cutting back on granular salt and swapping it for herbs and spices, cooking meals at home, and reading nutrition labels and choosing low-sodium products (140 mg or less).
- Aim for a healthy weight. Carrying extra weight, especially having obesity, can contribute to high blood pressure and proteinuria, says Voora. If you’re unsure whether your weight is affecting your health, your nephrology team can help you determine a healthy range for you. Small changes, such as being more physically active and making healthy food choices more often, can help as you work toward your goal weight.
- Find ways to move your body regularly. Activities like walking, swimming, cycling, and gardening can help lower blood pressure and protect your heart and kidneys.
- Don’t overlook stress management. Stress is part of everyday life. While it’s not possible to avoid completely, chronic stress can contribute to high blood pressure. Find healthy ways to manage stress, whether that’s meditation, deep breathing, prayer, spending time outdoors, or talking with loved ones.
- Make sleep a priority. Getting enough quality sleep isn’t always easy, especially when you’re managing a chronic condition. Sleep, however, can help with blood pressure regulation. Try to go to bed and wake up at the same time and create a comfortable sleep environment, such as keeping your room cool, dark, and quiet. If sleep remains a challenge, discuss it with your healthcare team.
Resources We Trust
- Cleveland Clinic: Here’s What Your Blood Pressure Numbers Mean
- Mayo Clinic: Diagnosed with IgAN? Here are 4 tips to help you manage your kidney health
- IgA Nephropathy Foundation: 8 Tips for Taking Control of Your Blood Pressure
- American Kidney Fund: High Blood Pressure and Kidney Health
- National Kidney Foundation: High Blood Pressure and Chronic Kidney Disease
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
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