In addition to foamy urine, blood in the urine, and leg swelling, fatigue is a common symptom of IgA nephropathy (IgAN). For some people, fatigue develops gradually as the kidney disease progresses. For others, it’s one of the most disruptive symptoms of IgAN, also known as Berger’s disease.
Reasons vary from anemia (low red blood cells) and medication side effects to stress and inflammation, says Steve Khalil, MD, a general nephrologist at RWJBarnabas Health Medical Group in New Brunswick, New Jersey.
1. Check for and Treat Anemia
Anemia is one of the most common and treatable causes of fatigue with IgAN, Dr. Khalil says, and tests can pinpoint it as a factor.
Red blood cells carry oxygen throughout the body, and when levels are low, your muscles and organs don’t get enough oxygen to produce energy. As a result, fatigue tends to linger, even with rest.
“A simple blood test can identify this, and treatment can make a meaningful difference in energy,” Khalil says.
Iron deficiency is closely tied to anemia, as well. Your body needs iron to make hemoglobin, the oxygen-carrying part inside the red blood cells. Anemia and low iron reduce how much oxygen is delivered throughout the body, says Stefanie Diaz, MD, a board-certified nephrologist and member of the teaching faculty at the University of Texas in Tyler.
Treatment options include iron supplements, medication, and potentially blood transfusions.
2. Prioritize Sufficient, Quality Sleep
Sleep affects your energy, and many people with IgAN are more fatigued when they don’t get enough rest. Getting poor sleep can increase inflammation, while getting enough sleep can help your body regulate inflammation, Dr. Diaz says.
Because IgAN is an immune-driven condition that causes kidney inflammation, managing that inflammation is key to addressing symptoms such as fatigue.
Regular, sufficient, and high-quality sleep can also help keep your blood pressure in a healthy range, says Christopher K. Johnson, MD, a nephrologist with RenalCare Associates in Peoria, Illinois, and the medical director of OSF Kidney Transplant.High blood pressure also puts stress on your kidneys.
Diaz and Dr. Johnson recommend numerous techniques to help you improve sleep quality and address fatigue:
Get seven to eight hours of sleep each night. Your body does a lot of repair and recovery when you sleep, and not getting enough sleep can worsen fatigue.
Keep a regular sleep schedule. Going to bed and waking up at the same time each day helps regulate your body’s internal clock, which can improve how rested you feel.
Take a break from electronics before you go to bed. The light from phones and tablets can keep you awake and make it harder for your body to realize it’s time to sleep.
Limit caffeine and alcohol. Both can interfere with sleep quality, even if alcohol initially makes you feel drowsy.
Cut back on fluids before bed. Reducing fluid intake two to three hours before bedtime can help minimize nighttime trips to the bathroom.
Consider your medications. Khalil suggests asking your care team if your medications might be affecting your sleep.
Get tested for sleep apnea. If you’re a heavy snorer or often feel tired despite getting enough hours of sleep, Johnson suggests talking to your doctor about sleep apnea, which is a common but treatable cause of fatigue.
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3. Review Your Medications With Your Nephrologist
Some medications used to treat IgAN or to manage blood pressure can cause fatigue, Johnson says. If you’ve been feeling more tired since starting a new medication, discuss it with your healthcare provider.
The effects of medications can also change over time. One you tolerated before may affect your energy differently as your kidney function changes.
Reviewing your medications from time to time with your healthcare provider is a good habit, Diaz says. In some cases, a dose adjustment or switching to another medication can help improve how you feel, she says.
“There are many different medications that can be helpful for IgAN,” Johnson says, “and being open with your doctor about side effects can help you choose the right one together.”
4. Stay Active With Light Exercise
Light exercise, if you can tolerate it, can help you manage fatigue with IgAN. For example, short daily walks can improve your stamina and energy over time, Khalil says. Start small and slow and increase physical activity gradually rather than trying to do too much at once.
Exercise can also help improve quality of life, mood, and depression in people with IgAN, Johnson says.
“It can also help lower blood pressure, which may reduce the amount of blood pressure medication needed to protect your kidneys,” he says.
Regular light exercise also can help with muscle strength, sleep quality, heart health, and inflammation, Diaz says.
Here are a few ways to get started safely:
Talk to your care team. Before you start a new exercise routine, Diaz suggests discussing it with your healthcare provider to make sure the activities you choose are a good fit for your health and needs.
Start with 10 to 15 minutes. This could be walking, light resistance training, or cycling.
Focus on consistency. It’s better to do a little bit most days, consistently, than to try a strenuous workout once a week.
Pay attention to how you feel. While staying active is helpful, it’s important to pace yourself. If you’re having a particularly tough day, a short, gentle stroll can still be helpful.
5. Adjust Your Diet
Some people focus so much on eating a kidney-friendly diet that they end up unintentionally undereating, Diaz says. If you don’t get enough calories or protein, your body doesn’t get the resources it needs to maintain muscle, repair tissues, and sustain energy — leading to fatigue.
An anti-inflammatory diet, such as the Mediterranean or DASH diets, can help you get the nutrients you need while avoiding things such as highly processed foods that make inflammation and fatigue worse. This diet typically includes fruits, vegetables, whole grains, and healthy fats.
To help you stay energized, consider these nutrition habits:
Eat balanced meals regularly. Although you may avoid eating certain foods or eating altogether, it’s important to get enough calories so your body doesn’t have to break down its own muscle for fuel.
Be mindful of hidden nutrient deficiencies. Iron, vitamin D, and vitamin B12 deficiencies can contribute to low energy, Diaz says. Ask your healthcare provider to check your levels of these micronutrients and ways to address them if they are low.
Talk to a dietitian. A renal dietitian can help you balance kidney protection with getting enough calories and nutrients and can suggest quality sources that might be best for you.
6. Take Care of Your Mental Health
Don’t overlook the mental and emotional toll of living with a chronic illness. The uncertainty and constant stress of managing IgAN, along with feelings of depression and anxiety, can make fatigue feel much more intense, Diaz says.
“As kidney function declines, it’s very normal for people to feel sad or a loss of control,” Johnson says. “It’s normal to worry about the future, about further kidney disease, and about scary things like dialysis and transplant.”
If you feel like your mental health is affecting your energy levels, discuss your concerns with your care team. These are common experiences with IgAN, and there are effective ways to address them.
Counseling, cognitive behavioral therapy (CBT), and support groups can help you process the emotional side of your diagnosis, Diaz says. Healthy stress management techniques — such as journaling, meditation, or a few minutes of focused breathing — can also give your mind a needed break, she says.
It’s just as important to stay connected to the people around you. Spending time with family and friends or staying involved in your community, even in small ways, can lift your mood and give you something to look forward to, which itself can help with energy, Diaz says.
7. Keep Communicating With Your Doctor
Talking openly with your care team about changes in your energy level is worthwhile, Khalil says.
A common misconception is that fatigue is just a part of IgAN and can’t be improved, he says. But many causes of fatigue, such as inflammation and sleep issues, aren’t obvious or seen in routine lab work. And they can be treated.
There are times, though, when fatigue deserves more immediate attention. Call your doctor promptly if your symptoms include:
Noticeable fatigue that lasts weeks
Urination changes
Reduced appetite
Difficulty sleeping or focusing
If something feels off or different from how you usually feel, it’s always appropriate to check in with your care team sooner rather than later.
The Takeaway
Fatigue is a common side effect of IgA nephropathy (IgAN). Causes include anemia, medication side effects, and anxiety, and many are treatable.
Quality sleep, regular light exercise, and healthy stress management techniques may help improve your energy levels over time.
Consuming enough calories and protein while reducing foods that increase inflammation is key to getting the energy you need while preventing fatigue from worsening.
Notify your healthcare provider right away if your fatigue interferes with your daily activities or if you experience changes to your urination, reduced appetite, or difficulty focusing and sleeping.
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Besedovsky L et al. Differential Effects of an Experimental Model of Prolonged Sleep Disturbance on Inflammation in Healthy Females and Males. PNAS Nexus. March 2022.
Ghozloujeh ZG et al. IgA Nephropathy: An Overview of the Clinical Trials. Kidney Medicine. October 2025.
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Igor Kagan, MD, is an an assistant clinical professor at UCLA. He spends the majority of his time seeing patients in various settings, such as outpatient clinics, inpatient rounds, and dialysis units. He is also the associate program director for the General Nephrology Fellowship and teaches medical students, residents, and fellows. His clinical interests include general nephrology, chronic kidney disease, dialysis (home and in-center), hypertension, and glomerulonephritis, among others. He is also interested in electronic medical record optimization and services as a physician informaticist.
A native of Los Angeles, he graduated cum laude from the University of California in Los Angeles (UCLA) with a bachelor's in business and economics, and was inducted into the Phi Beta Kappa honor society. He then went to the Keck School of Medicine at the University of Southern California (USC) for his medical school education. He stayed at USC for his training and completed his internship and internal medicine residency at the historic Los Angeles County and USC General Hospital. Following his internal medicine residency, Kagan went across town to UCLA's David Geffen School of Medicine for his fellowship in nephrology and training at the UCLA Ronald Reagan Medical Center. After his fellowship he stayed on as faculty at UCLA Health.
Maggie Aime is a registered nurse with over 25 years of healthcare experience, who brings medical topics to life through informative and inspiring content. Her extensive nursing background spans specialties like oncology, cardiology, and pediatrics. She has also worked in case management, revenue management, medical coding, and as a utilization review nurse consultant. She leverages her unique insights to help individuals navigate the U.S. healthcare system and avoid financial pitfalls.
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