It's National Kidney Month!

Chronic Kidney Disease 

It’s National Kidney Month, so let's get real about Chronic Kidney Disease (CKD), or chronic renal failure. Trust us,

We all know about screening for heart disease and cancers, yet as the 6th leading cause of death in the US, kidney disease kills more Americans and creates more years of disability than both colon and breast cancers. Why aren’t we talking more about this?

While a common blood test can detect early stages of kidney dysfunction, these early warning signs often go overlooked. Patients are too often not alerted of this diagnosis until it has progressed to later stages, when greater medical intervention is necessary. The information below will help you understand your lab tests, know when to talk to your doctor about further testing, and steps you can take now to keep your kidneys healthy for decades to come.  

​
Diagnosis and Staging: Am I at risk?
Kidney disease is diagnosed and staged using two simple lab tests:

• GFR (or eGFR) - This is a blood test that shows how efficiently your kidneys filter, or clean, the blood. This test is part of a metabolic panel (or CMP) that is typically included on routine annual screening blood work. Lower levels indicate aging or damaged, less-efficient kidneys. 
• Albumin:creatinine ratio (ACR) or protein:creatinine ratio - This is a urine test that shows if your kidneys are leaking protein into your urine. Proteins are large molecules that should not be able to get through the small pores of the kidney filtration unit, so higher levels of proteins in the urine indicate some damage. 

Stages of CKD 

• Stage 1 with normal GFR (> 90 mL/min) and mildly elevated ACR (>30)
• Stage 2 Mild CKD mildly low GFR (60-89 mL/min) and mildly elevated ACR (>30)
• Stage 3A Moderate CKD moderately low GFR (45-59 mL/min)
• Stage 3B Moderate CKD moderately to severely low GFR (30-44 mL/min)
• Stage 4 Severe CKD Severely low GFR (15-29 mL/min)
• Stage 5 End Stage CKD Kidney failure (GFR <15 mL/min)

You must have consistently abnormal result over at least 3 months for diagnosis. If you have a GFR less than 90 at any point, consider asking your medical provider to repeat the testing and include an ACR test to confirm a diagnosis and get a full understanding of your risk. 

An important note on lab testing: GFR is considered “normal” on standard lab ranges until it drops below 60. As you see from the staging criteria above, once you drop below 60 you are already at moderate disease activity, and this value correlates with 75% loss of kidney function! Because your lab test reads “normal,” many people are not alerted to declining kidney function until later stages. However, the good news is that because GFR declines with age, having a modestly low GFR without a high ACR means that you are very unlikely to develop more severe kidney disease.  

Preventative and Naturopathic Treatment:
Early detection of kidney dysfunction is critical, as there are many proactive steps you can take to protect your kidneys and prevent further damage. Here I review some of the most important preventative actions to protect your kidneys: 

• Limit or avoid substances that are toxic to the kidneys, including: NSAID pain medications (ibuprofen, aspirin, aleve, etc), alcohol, certain antibiotic medications (neomycin, gentamycin, cyclosporins), antiviral medications (acyclovir), bisphosphonates (reclast), pesticides/herbicides and  imaging contrast dyes (iodine,  gadolinium). Diuretic medications (Lasix, spironolactone) can be risky in those with existing kidney issues, as they force hyperfiltration of already stressed kidneys. 
• Manage other medical conditions that damage the kidneys: high blood pressure and diabetes/prediabetes are the most common conditions that damage the kidneys, and can be aggressively managed with diet and lifestyle to protect the kidneys.
• Hydration: For healthy kidney function, consume about 80-100 oz of water daily. You may need more based on exercise, caffeine intake, and diuretic medications. Those with kidney disease may need to limit water intake to avoid forcing the kidneys to hyperfilter, so check with your medical provider on the right amount for you. 
• Nutrition: An organic, whole foods diet that limits processed food, soda, alcohol, and sugar is the best preventative medicine for your kidneys. Include at least 5 cups of colorful fruits and veggies daily, as the antioxidants in these foods reduce inflammation. Freshly ground flax seeds (2-3 Tbls daily) and kombu seaweed are excellent additions to support kidney health. Those with existing kidney diseases, particularly stage 3B or higher, need to consume a low protein, vegetarian diet to prevent further damage. High protein diet may stress the kidneys, even in those without underlying disease; there can be many benefits from consuming high protein for other medical conditions, but added kidney support may be necessary to prevent damage if doing so over extended periods of time. 
• Herbal support: Herbs are highly effective medications for the kidneys, and are very effective for lowering ACR and increasing GFR. For broad spectrum support, choose Kidney Korrect (2 capsules daily on empty stomach), a blend of medicinal mushrooms and herbs that works well to increase/correct GFR in early stages. For high ACR or proteinuria, choose ProOmega 2000, a high potency, purity-tested fish oil; the dose shown to reduce or eliminate protein in the urine is 5 capsules (5000mg) daily with food.