KIDNEY DISEASE

WHAT ARE THE KIDNEYS AND WHY ARE THEY IMPORTANT?

In the human body, there are two kidneys, one located on each side of the spine.  These vital, bean-shaped organs are part of the urinary system (1,2).

The functions of the kidney are important for maintaining many processes in the body. The main functions of the kidney are to:

• Produce urine, which is how the kidney filters waste, such as ammonia and urea, as well as drugs and toxins from the body
• Maintain a balance of chemicals like sodium and potassium in the body
• Maintain water balance in the body
• Produce renin, which is responsible for increasing blood pressure
• Produce the hormones calcitriol and erythropoietin
• Maintain blood sugar levels by producing sugar from glutamine if normal glucose levels run low (1,3)

RISK FACTORS AND SYMPTOMS OF KIDNEY DISEASES

Acute Kidney Injury

Acute kidney injury, which is also known as acute renal failure, is the reduction of filtration by the kidneys, resulting in the buildup of wastes, specifically, nitrogen and creatinine (4). This can lead to kidneys malfunctioning in a matter of hours or days and can be life-threatening if not treated. There are three categories of acute kidney injury namely prerenal, renal and postrenal depending on what part of the kidney is affected.

Risk factors

• Being hospitalized
• Advanced age
• Blockages in the blood vessels in your arms or legs (peripheral artery disease)
• Diabetes
• High blood pressure
• Heart failure
• Kidney diseases
• Liver diseases (5)

Symptoms

• Decreased urine output
• Fluid retention
• Shortness of breath
• Fatigue
• Confusion
• Nausea
• Irregular heartbeat
• Chest pain or pressure (5)

Chronic Kidney Disease

Chronic kidney disease is damage to the kidneys causing prolonged impairment of its functions. This results in the build of fluid and wastes in the human body (6). Varying kidney conditions lead to the development of chronic kidney disease.

Risk factors

• Diabetes
• High blood pressure
• Heart and blood vessel (cardiovascular) disease
• Smoking
• Obesity
• Being African-American, Native American or Asian-American
• Family history of kidney disease
• Abnormal kidney structure
• Older age (7)

Symptoms

• Nausea
• Vomiting
• Loss of appetite
• Fatigue and weakness
• Sleep problems
• Changes in how much you urinate
• Decreased mental sharpness
• Muscle twitches and cramps
• Swelling of feet and ankles
• Persistent itching
• Chest pain
• Shortness of breath
• High blood pressure (hypertension) (7)

Polycystic Kidney Disease (PKD)

This is a common genetic kidney disorder that causes fluid-filled cysts to grow on the kidneys. The cysts can change the shape of the kidney, making it larger than it should be.

Risk factors

• Genetic/family history of PKD

Symptoms

• High blood pressure
• Pain in lower back on either or both sides of the spine
• Feeling of being full
• Distended abdomen
• Blood in urine
• Kidney stones
• Urinary tract infections (8)

Glomerulonephritis

The glomerulus is the membrane tissue in the kidney that filters waste and fluids from the blood. Glomerulonephritis is the inflammation of this tissue, which can lead to the leakage of proteins and red blood cells into the urine and build of waste in the blood (9).

Risk factors

• Infections
• Diabetes
• Autoimmune diseases (10,11,12)

Symptoms

• Blood in the urine
• Abnormal amount of proteins in the urine
• Hypertension
• Swelling in extremities, abdomen, and face (13,14)

Kidney Stones

This is a common occurrence in the kidney, where the urine becomes oversaturated with salts, which begin to crystallize and form stones. These can be struvite stones, uric acid stone or the most common, calcium stones (15).

Risk factors

• Presence of cysts on the kidney
• Family history of kidney stones
• Dehydration
• Certain diets high in salt
• Lack of citrate in the urine due to ongoing diarrhea
• Certain drugs such as diuretics and decongestants
• History of high blood pressure and gout (15,16)

Symptoms

• Pain and discomfort in the lower back and abdomen
• Restlessness
• Vomiting
• Nausea (15,16)

For more information on kidney disease and diagnosis:  1. Talk to your doctor  2. Visit the National Kidney Disease website  3. Visit the Mayo Clinic website  4. Visit the MedlinePlus website

RECENT FACTS OR STATISTICS ON KIDNEY DISEASES

• In 2017, the CDC estimated that 30 million adults (15% of the population) in the United States had chronic kidney disease (17).
• In 2016, 661,000 adults in the United Stated had kidney failure. Within this amount, 468,000 persons were on dialysis, and the remaining 193,000 persons had a functioning kidney due to transplant surgery (18)
• End-stage renal disease was found to be 3.7 times more prevalent in African Americans when compared to Caucasians, 1.4 times more prevalent in Native Americans when compared to Caucasians, and 1.5 times greater in Asian Americans to Caucasians (18).
• Estimates have also shown that kidney diseases are responsible for more deaths each year when compared to breast cancer and prostate cancer (18).

MEDICAL TREATMENT OF KIDNEY DISEASES

Acute Kidney Injury

Treatment or management of acute kidney injury is mostly supportive and require hospitalizations. For balancing fluids in the body, isotonic solutions, such as saline, are used, with the goal of maintaining a healthy blood pressure (19).

Additionally, treatments to maintain the balance of electrolytes in the body is important, to prevent potassium build up in the bloodstream. This is done with prescribed glucose, calcium or sodium polystyrene sulfonate (20).

Sodium polystyrene sulfonate is marked at Kayexalate and Kionex to treat hyperkalemia. Side-effects of these drugs include gastrointestinal problems such as nausea, vomiting, diarrhea, and constipation, as well as hypokalemia, hypomagnesemia, hypocalcemia and colonic necrosis, which is the most serious side-effect (20,21).

If there is toxin build up in the body, dialysis may be required. Dialysis is the cleansing of the blood by removing waste and excess water (22). Dialysis is done by a machine that basically replaces the functions of the kidneys when the kidneys are too damaged to function properly. Side-effects of dialysis include thyroid problems, cardiovascular concerns, and oxidative stress all related to inflammation (22).

Chronic Kidney Disease

The focus of treatment for chronic kidney disease is on renal and cardiovascular risk factors, such as the control of blood glucose and lipids, blood pressure, and albumin (23).

• Sitagliptin: marketed as Januvia, Xelevia (24).  Side-effects include pancreatitis, low blood sugar, kidney problems, cardiovascular problems, skin allergies, joint pain, nausea and vomiting, fever, edema, possible liver toxicity, fast heart rate (25).
• Vildagliptin: marketed as Galvus, Xiliarx (26).  Side-effects include possible hypoglycemia, excessive sweating, tremors, hunger, mild to moderate gastrointestinal problem (27,28).
• Saxagliptin: marketed as Onglyza (29).  Side-effects include possible acute liver injury, pancreatitis, interactions with other diabetes medications resulting in low blood sugar, skin allergies, rapid weight gain, edema, fatigue, chills, joint pain, severe gastrointestinal problems such as vomiting, nausea and diarrhea, blood in urine and lower back pain (29,30).

Polycystic Kidney Disease (PKD)

Treatment for PKD usually involves therapies to prevent further kidney disease. While some research indicates that statins are useful drugs for this disease due to its inhibitory process to slow the growth of renal cysts, other studies suggest that statins are not beneficial in treating the disease and call for further clinical research to be done (31,32,33,34).

Glomerulonephritis

• Angiotensin-converting enzyme (ACE) inhibitors (35): marketed as Vasotec, Enalaprilum.  Side-effects include further kidney and liver problems, low blood pressure, swelling in the head, neck and intestines and dizziness (35,36)
• Corticosteroids (37): marketed as Deltasone, Dehydrocortisone, Prednicot, Rayos, Decortin, and Sterapred (38).  Side-effects include rapid weight gain, edema, gastrointestinal problems such as stomach pain, vomiting, nausea and diarrhea, muscle pain, weak bones, mood changes, depression, cataracts, glaucoma, hypertension, growth retardation in children, susceptibility to infections, fever and chills, fatigue, skin changes, and headaches (39).

Kidney Stones

Kidney stones usually pass on their own. However, there are some pharmacological treatments that are used to treat and remove kidney stones.

• Extracorporeal Shock Wave Lithotripsy – noninvasive use of an instrument to emit sound waves against the skin to break down the kidney stones for easy passage out of the body (40,41).  Side-effects can include flank pain and lesions to the kidney tissues and vessels, as well as lesions to tissues and vessels of surrounding organs (41).

NATURAL WAYS TO HELP SUPPORT HEALTHY KIDNEYS

Practices to Help Support Healthy Kidneys:

• Exercise
• Eat a well-balanced (42,43,44)
• Stop smoking (45,46)

Natural Supplements That Help Support Healthy Kidneys

• Milk Thistle (47,48)
• Astragalus (49,50)
• Licorice Root (51,52)

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