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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.  

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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. 

Nothing says October like pumpkins! If you've carved your jack o'lanterns and have more pumpkin seeds than you know what to do with, this recipe is for you. This pumpkin pie granola is tasty and easy to make, and the house smells great while it's baking. The recipe below is delicious and nutritious, and one of the great things about granola is that you can add in whatever you what - nuts, seeds, or dried fruit. We eat it with homemade cashew milk (recipe included), but of course you can eat it with whatever you like with your granola.

Dry ingredients:
3 cups rolled oats
2 cups raw pumpkin seeds
1 tablespoon pumpkin pie spice
1/2 teaspoon sea salt

Wet ingredients:
1/2 cup melted coconut oil
1/2 cup maple syrup
1/2 cup pureed pumpkin (either canned or fresh)
1 teaspoon vanilla

Additions
1/2 to 1 cup raisins, currants, dried apples, etc.

• Preheat oven to 300º F. 
• Combine all dry ingredients in a large bowl and mix together. Combine all wet ingredients in a small bowl and whisk together. Pour wet ingredients into dry ingredients bowl and mix well.
• Spread granola out on a rimmed cookie sheet and bake for 45 to 60 minutes, stirring 2 or 3 times as it's baking. Then, remove granola from oven and cool - it crisps up as it cools.
• Once granola is cool, mix in any dried fruit that you want to add. Store in a glass jar for up to 2 weeks.

Makes 5 to 6 cups
From Nourishing Meals by Alissa Segersten and Tom Malterre
 

Cashew Milk
1/2 cup raw cashews
2 cups water
2 tablespoons maple syrup
pinch sea salt

• Place all ingredients into a high-powered blender. Blend on high until very smooth. Taste and adjust sweetness if necessary. (If you don't have a high-powered blender, soak the cashews for 3 hours. Drain them and follow the recipe using a regular blender.)
• Store in a covered glass jar or pitcher in the refrigerator for up to 4 days.

Makes 2 1/2 cups
From Nourishing Meals by Alissa Segersten and Tom Malterre 

Fall brings chilly weather and, for many of us, a busy schedule. This recipe is perfect for both. With only a few minutes of work in the morning, all the ingredients for this hearty, satisfying stew can be put in a crock pot and left to cook for the day. When everyone returns from work and school, they will be greeted by the rich, delicious smell of a hot dinner. Enjoy!  

1 medium onion, diced
4 large carrots, cut into 1/4 inch rounds
1/2 pound mushrooms, sliced or quartered
1 pound organic, grass-fed beef stew meat
1/2 cup water
1/4 cup dry red wine
1/4 cup tomato sauce
2 tablespoons arrowroot powder or sweet rice flour
1 1/4 teaspoons sea salt
1/2 teaspoon ground black pepper

• Place the onion, carrots, mushrooms, and stew meat into a 3-quart slow cooker. In a small bowl whisk together the water, wine, tomato sauce, and arrowroot. Pour into the slow cooker. Add salt and pepper. Mix all ingredients together. There won't be enough liquid to cover the ingredients. This is how it should be, so don't be tempted to add more liquid.
• Cook on high for 4 hours or on low for 8 hours. If you like, crack the lid for the last 45 minutes to cook off some liquid to create a thicker stew.

Makes 4 servings
From Nourishing Meals by Alissa Segersten and Tom Malterre 

If you've eaten any Vietnamese food, this is probably it. Pho is a delicious, fragrant noodle soup filled with fresh vegetables and garnished however you like, which makes it a great meal if everyone in your family has differing palates. It's traditionally made with meat and is often eaten for breakfast, but we skip the meat and have it at dinner instead. If you'd rather, substitute chicken or beef for the tofu. After cubing the tofu we sometimes fry it in a skillet with 2-3 tablespoons coconut oil. After cutting it, be sure to pat it dry with a dishtowel or paper towels. Put it in the skillet on medium heat and turn it once one side has browned. Keep turning it until they are fried to your liking. Alternatively, you can toss the plain, uncooked tofu into the broth which will save you some time. We use pad thai brown rice noodles for this recipe, which are wide and flat, similar to linguine.
 
Broth:
1 small onion, unpeeled and quartered
2 shallots, unpeeled, halved
8 cloves garlic, halved
1-2 inch piece ginger root, coarsely sliced
2 cinnamon sticks
1 teaspoon fennel seeds
10 cloves
10 cups water or clear vegetable stock
3 tablespoons soy sauce or Bragg’s liquid aminos
 
Other ingredients:
1 pound pad thai brown rice noodles
4 cups baby spinach, green cabbage, bok choy or other dark greens, chopped
2 14 oz. containers extra-firm tofu, cubed, and fried in coconut oil if desired
6 scallions, thinly sliced, both green and white parts
1 ½ cups mung bean sprouts
1 jalepeno pepper, sliced
1 cup chopped and toasted cashews or peanuts
1 lime, cut into wedges
cilantro, to taste
basil or mint, to taste
sriracha sauce or crushed red pepper
hoisin or plum sauce

• To make the broth, heat a large pot over medium heat. Add the onion, shallots, garlic, ginger, cinnamon sticks, fennel, and cloves. Dry roast, stirring occasionally until the veggies begin to char. Add the stock or water and soy sauce and bring to a boil on high heat. Turn heat down to low, cover and simmer at least 30 minutes or until ready to serve. Strain into a clean pot and discard the solids (or just be careful not to serve the solids). Taste and add salt if needed (if you use broth, you probably won't need any).
• While the broth is simmering, prepare the rice noodles. Bring a medium pot of water to a boil and add the noodles. Follow directions for cooking on noodle bag or box or until they are the firmness you like. Drain when done into a colander and then rinse with cold water.
• Put cashews or peanuts in a small skillet and dry roast them, stirring or tossing frequently, until they begin to brown and become fragrant. When they are to your liking, put them in a small bowl.
• When you are ready to assemble the soup, add tofu to the broth to heat through. Divide rice noodles between serving bowls.  Put greens, bean sprouts, and tofu in each bowl.  Serve other ingredients on a separate platter so everyone can garnish their pho as they wish.

 
Serves 6
Adapted from the Vegetarian Pho recipe at http://www.food.com/recipe/vegetarian-pho-238765.