Medical Help for C3G Fatigue
Your nephrologist will usually consider your symptoms, medication schedule, sleep, mood, daily function, and laboratory results.
Zeitler says testing may include:
- A complete blood count and iron studies for anemia or iron deficiency
- Creatinine, estimated glomerular filtration rate (eGFR), electrolytes, and bicarbonate to assess kidney function and acid balance
- C-reactive protein, complement levels, and other C3G markers to assess inflammation and disease activity
- Thyroid and vitamin D tests
- Screening for depression and questions about sleep apnea, restless legs syndrome, or other sleep problems
Depending on what is contributing to the fatigue, these are some possible treatments.
Treat the C3G Itself
“Effective treatment of C3G can reduce kidney inflammation and proteinuria and slow the decline in kidney function,” Zeitler says. Reducing protein loss may also help ease swelling and loss of muscle mass.
Treat Anemia or Iron Deficiency
Treatment may include iron and, in some cases, an erythropoiesis-stimulating agent (ESA). “Partially correcting anemia can meaningfully improve fatigue and physical function,” Zeitler says. Doctors don’t aim to raise hemoglobin to normal levels with an ESA because higher targets can increase cardiovascular risk, he adds.
Manage Blood Pressure, Protein Loss, and Swelling
ACE inhibitors or angiotensin receptor blockers may lower blood pressure and reduce protein loss, while diuretics can help relieve fluid buildup.
Correct Excess Acid in the Blood
Low bicarbonate, which can result from acidosis (too many acids in the blood), may be treated with sodium bicarbonate or sodium citrate, says Zeitler. “However, I have not found this to provide much benefit for my patients with acidosis, and the pill burden can be high,” he says. Talk with your doctor about the pros and cons of treating bicarbonate.
Adjust Medications That May Be Adding to Fatigue
If prednisone is disrupting sleep, your doctor may change when it is taken or gradually lower the dose once C3G is under control.
Another option could be to change the formulation or dose of mycophenolate if digestive symptoms or low blood counts are a problem, or consider another blood pressure medicine if a beta-blocker appears to be worsening fatigue. “Don’t make these changes on your own,” says Zeitler.
Treat Sleep Problems
Sleep apnea, restless legs syndrome, pain, and poor sleep quality can all make fatigue worse in people with chronic kidney disease.
Work With a Renal Dietitian
A dietitian can assess whether appetite loss, dietary restrictions, digestive symptoms, or inadequate calorie and nutrient intake are contributing. “Small, frequent meals may be easier to manage when appetite is low,” Hardie says.
Protein, sodium, fluid, potassium, and phosphorus recommendations should be tailored to kidney function, laboratory results, other health conditions, and whether you are receiving dialysis. Hardie recommends bringing recent lab results and a food record so the dietitian can estimate calorie and nutrient intake and identify anything that may be interfering with eating.
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