Elevated Immunoglobulin Levels and Kidney Health Risks

Elevated immunoglobulin levels?

Doctor: Hello! Recently in April, I went to the hospital due to shortness of breath and chest tightness, where cardiac examinations showed no issues, and it was later diagnosed as autonomic nervous system dysfunction.
However, the urine tests revealed hematuria and proteinuria (++).
I was then referred to a nephrology outpatient clinic, where a kidney ultrasound showed fibrosis in one of the kidneys (with a lighter color), and my immunoglobulin levels were elevated (around 440).
The doctor mentioned that the current kidney function tests (blood and urine tests) are normal, including the daily protein excretion being comparable to that of a healthy individual, so I just need to continue monitoring without medication.
I would like to ask if this is a type of glomerulonephritis? Is a biopsy necessary? What kind of impact could this condition have in the future? Will it inevitably worsen to the point of requiring dialysis? If I plan to become pregnant in the future, will it significantly affect my kidneys? Additionally, my father has hypertension, and my blood pressure is somewhat elevated (around 110/70 in the morning and evening, but often 140/90 while at work).
Does this situation require blood pressure management?

kiki, 30~39 year old female. Ask Date: 2005/06/27

Dr. Yao Quan reply Internal Medicine

Dear Ms.
Kiki,
Hello.
There are five types of immunoglobulins: IgG, IgA, IgM, IgD, and IgE, each with different normal value ranges.
Your letter mentions elevated immunoglobulin levels (approximately 440), but it is unclear which specific immunoglobulin is elevated.
The normal range for immunoglobulin A (IgA) is 90-325 mg/dL, so it is possible that your condition involves elevated IgA levels.

If IgA is elevated in the blood and there is also hematuria or proteinuria in the urine, we need to consider the possibility of IgA nephropathy.
To confirm the diagnosis, a renal biopsy may be necessary, although it is not always required.
If it is IgA nephropathy, a portion of patients may progress to the point of requiring dialysis (approximately 10% after 10 years and about 20% after 20 years).
Generally, for women with progressive kidney disease, it is advisable to complete childbearing while kidney function is still good.
For women with mild kidney disease (serum creatinine less than 1.4 mg/dL), the fetal survival rate is only slightly reduced, and the pre-existing kidney condition typically does not worsen.
In cases of moderate to severe renal insufficiency, pregnancy can exacerbate hypertension and kidney disease.
There is a negative correlation between the birth weight of the infant and the mother's serum creatinine levels.
Therefore, since your kidney function remains normal, becoming pregnant in the near future should not typically worsen your existing kidney condition (if any).
Given your history of hematuria and proteinuria++, I recommend ongoing monitoring.
Blood pressure should also be monitored, and if it is elevated, appropriate measures should be taken to control it.
Sincerely,
Dr.
Yao Quan, Internal Medicine

Reply Date: 2005/06/27

More Info

Elevated immunoglobulin levels can be indicative of various underlying conditions, including potential kidney issues. In your case, the presence of hematuria (blood in urine) and proteinuria (protein in urine) alongside elevated immunoglobulin levels raises concerns about possible kidney involvement, particularly conditions like IgA nephropathy or other forms of glomerulonephritis. However, the fact that your kidney function tests (blood and urine) are currently normal and that your doctor has recommended monitoring rather than immediate intervention is a positive sign.

Understanding Elevated Immunoglobulin Levels
Immunoglobulins are antibodies produced by the immune system to help fight infections. There are five main types: IgG, IgA, IgM, IgD, and IgE. Elevated levels of immunoglobulins can occur due to chronic infections, autoimmune diseases, or certain malignancies. In your case, the specific type of immunoglobulin that is elevated would provide more insight into the underlying cause. For instance, elevated IgA levels are often associated with IgA nephropathy, a common form of kidney disease.

Kidney Health and Risks
The presence of blood and protein in urine can be a sign of kidney damage or disease. Glomerulonephritis, which can be caused by infections, autoimmune diseases, or other conditions, can lead to elevated immunoglobulin levels and may result in kidney damage over time. Your kidney ultrasound showing fibrosis in one kidney is also a concern, as it suggests some degree of chronic damage.

Need for Further Testing
While your doctor has indicated that further immediate intervention is not necessary, you might still consider discussing the possibility of a kidney biopsy (pathological examination) with your nephrologist. A biopsy can provide definitive information about the type of kidney disease you may have and guide treatment options. It is particularly useful if there is suspicion of glomerulonephritis or other specific kidney conditions.

Long-term Implications
As for the long-term implications, it is essential to understand that while some kidney diseases can progress to end-stage renal disease (ESRD) requiring dialysis, many patients with mild to moderate kidney issues can maintain their kidney function with proper management. The statistics you mentioned indicate that a small percentage of patients with IgA nephropathy progress to dialysis within 10 to 20 years. Regular monitoring of kidney function, blood pressure, and protein levels in urine will be crucial in managing your condition.

Pregnancy Considerations
Regarding pregnancy, if you have underlying kidney disease, it is advisable to consult with a nephrologist and an obstetrician specializing in high-risk pregnancies. Generally, if kidney function is stable, many women with mild kidney issues can have successful pregnancies. However, pregnancy can put additional stress on the kidneys, especially if there are existing conditions like hypertension, which you mentioned. Your blood pressure readings indicate that you may need to monitor and potentially manage your blood pressure more closely, especially during pregnancy.

Blood Pressure Management
Given your family history of hypertension and your own elevated readings, it is prudent to focus on lifestyle modifications such as a balanced diet low in sodium, regular exercise, and stress management. If your blood pressure remains elevated, medication may be necessary to prevent complications, particularly in the context of kidney health.

Conclusion
In summary, while elevated immunoglobulin levels and the presence of hematuria and proteinuria warrant careful monitoring and possibly further investigation, your current kidney function appears stable. Regular follow-ups with your healthcare provider, maintaining a healthy lifestyle, and managing blood pressure will be key components in safeguarding your kidney health and overall well-being. If you have any further questions or concerns, do not hesitate to reach out to your healthcare team for personalized advice and support.

Similar Q&A

High Kappa Immunoglobulin Levels: Understanding Potential Health Risks

Hello, I am a 48-year-old male, 166 cm tall and weighing 66 kg, with hereditary Mediterranean anemia. I had a urinary stone in 2012, but it passed naturally. I do not have hypertension (January 2018 readings: 122 mmHg systolic, 77 mmHg diastolic) or hyperglycemia (fasting blood g...

Dr. Wu Jiyu reply Internal Medicine
Based on your inquiry, I can provide you with some recommendations: 1. The eGFR of 55 is slightly low, and the urine microalbumin/creatinine ratio of 303.4 mg/g is elevated; it is advisable to have long-term follow-up with a nephrologist. 2. Regarding the immunoglobulin levels, K...

Understanding Chronic Glomerulonephritis: Risks and Management

Hello Director Wu: I have hypertension and dyslipidemia (controlled with medication), as well as proteinuria. Since last year, my creatinine levels have fluctuated, sometimes above 1.2 and sometimes above 1.3. My most recent creatinine level was 1.33, with a glomerular filtration...

Dr. Wu Jiyu reply Internal Medicine
Based on your question, "Creatinine is 1.33 with a glomerular filtration rate of 62.1 ml/min/1.73 m²," it can be simply stated that at your age, the glomerular filtration rate should be greater than 90 ml/min/1.73 m². Additionally, you mentioned having hypertension, dys...

Understanding Elevated Total Protein and Globulin Levels in Blood Tests

Recently, during a health check-up, I had two elevated values: total protein (TP) and globulin (GLO). All other blood counts, as well as urine kidney function and liver function tests, were normal. The serum total protein (TP) was 8.7 g/dL, albumin (ALB) was 4.8 g/dL, and globuli...

Dr. Gao Jiankai reply Internal Medicine
Hello, thank you for your inquiry. I think it's okay. In addition to looking at the values, we also consider the albumin/globulin ratio, so there shouldn't be any issues. If you're still concerned, you can visit the Allergy, Immunology, and Rheumatology Department....

High Immunoglobulin Levels: Potential Indicators of Blood Disorders

The health check results show elevated immunoglobulin levels, with total protein at 6.8 g/dL, albumin at 4.6 g/dL, and globulin at 2.2 g/dL (highlighted in red). A subsequent blood test revealed IgG at 968 mg/dL, IgA at 206 mg/dL, and IgM at 261 mg/dL (highlighted in red). Free k...

Dr. Chen Yunfang reply Oncology
Hello: Free kappa 11.83, Free lambda 1.54, Kappa/lambda ratio 7.68. Only this ratio is abnormal; the standard K/L ratio is 1/1. All other values you provided are normal (however, we cannot draw conclusions as the lab report you provided is incomplete). I cannot give recommendatio...