Kidneys remove waste products from the body, keep the body chemicals in balance, and help maintain the body's water balance. There are a number of different kidney (renal) problems that may occur. The kidneys may be damaged by exposure to certain drugs or toxins, including heavy metals, solvents, chemotherapy agents, snake or insect venom, poisonous mushrooms, and pesticides. Impaired kidney function or renal failure can also accompany or result from many other disorders, such as congestive heart failure, diabetes, lupus, chronic hypertension, sickle-cell anemia and liver disease.
The kidneys are bean-shaped organs in the abdomen of the human body. The kidneys filter wastes from the blood and excrete them, along with water, as urine. There is one kidney on each side of the spine in the lower middle of the back. The right kidney sits just below the liver. The left kidney sits below the diaphragm and next to the spleen. They are surrounded by two layers of fat which help cushion them. Each kidney weighs about 1/4 pound and contains approximately 1 million filtering units called nephrons. Each nephron is made of a glomerulus and a tubule. The glomerulus is a miniature filtering and sieving device while the tubule is a tiny tube-like structure attached to the glomerulus.
The kidneys are connected to the urinary bladder by tubes called ureters. Urine is stored in the urinary bladder until the bladder is emptied by urinating. The bladder is connected to the outside of the body by another tube-like structure called the urethra.
The most important function of the kidneys is the removal of waste products produced by metabolism and excess water from the blood, assisting in the homeostasis of the body by regulating the balance of ions and water in the blood. The kidneys process about 200 liters of blood every day and produce about 2 liters of urine. The waste products are generated from normal metabolic process including the breakdown of active tissues, ingested foods, and other substances. The kidneys allow consumption of a variety of foods, drugs, vitamins and supplements, additives, and excess fluids without worry that toxic by-products will build up to harmful levels. The kidney also plays a major role in regulating levels of various minerals such as calcium, sodium and potassium in the blood.
THE FILTRATION PROCESS
As the first step in filtration, blood is delivered into the glomeruli by microscopic leaky blood vessels called capillaries. Here, blood is filtered of waste products and fluid while red blood cells, proteins, and large molecules are retained in the capillaries. In addition to wastes, some useful substances are also filtered out. The filtrate collects in a sac called Bowman's capsule and drains into the tubule.
The tubules are the next step in the filtration process. The tubules are lined with highly functional cells which process the filtrate, reabsorbing water and chemicals useful to the body while secreting some additional waste products into the tubule.
OTHER FUNCTIONS OF THE KIDNEYS
Additionally, the kidneys help maintain a person's blood pressure. When blood pressure becomes low, the kidneys secrete an enzyme called Renin that increases water absorption and blood volume which raises the blood pressure.
The kidneys also produce and secrete a variety of necessary hormones that have important functions in the body, including:
- Renin, which regulates blood volume and blood pressure.
- Erythropoietin (EPO), which stimulates the bone marrow to produce red blood cells.
- Urodilatin, which is a hormone that causes diuresis through increasing renal blood flow. It is secreted in response to increased mean arterial pressure and increased blood volume from the cells of the distal tubule and collecting duct. It is important in oliguric patients (such as those with acute renal failure and chronic renal failure) as it lowers serum creatinine and increases urine output.
- Vitamin D (calcitriol or 1,25 dihydroxy-vitamin D), which regulates absorption of calcium and phosphorus from foods, promoting formation of strong bone.
DIFFERENCE BETWEEN KIDNEY FAILURE AND KIDNEY DISEASE
Kidney Failure: Kidney failure occurs when the kidneys partly or completely lose their ability to carry out normal functions. This is dangerous because water, waste, and toxic substances build up that normally are removed from the body by the kidneys. It also causes other problems such as anemia, high blood pressure, acidosis (excessive acidity of body fluids), disorders of cholesterol and fatty acids, and bone disease in the body by impairing hormone production by the kidneys.
Chronic Kidney Disease: Chronic kidney disease is when one suffers from gradual and usually permanent loss of kidney function over time. This happens gradually over time, usually months to years. Chronic kidney disease is divided into five stages of increasing severity (see Table 1 below). Stage 5 chronic kidney failure is also referred to as end-stage renal disease, wherein there is total or near-total loss of kidney function and patients need dialysis or transplantation to stay alive. The term "renal" refers to the kidney, so another name for kidney failure is "renal failure." Mild kidney disease is often called renal insufficiency.
Unlike chronic kidney disease, acute kidney failure develops rapidly, over days or weeks. Acute kidney failure usually develops in response to a disorder that directly affects the kidney, its blood supply, or urine flow from it. Acute kidney failure usually does not cause permanent damage to the kidneys. With appropriate treatment of the underlying condition, it is often reversible, with complete recovery. In some cases, though, it may progress to chronic kidney disease.
STAGES OF CHRONIC KIDNEY DISEASE
Chronic kidney disease is defined as either kidney damage or glomerular filtration rate (GFR - the measurement of the kidney's function) <60 mL/min/1.73 m² for >/= 3 months according to the Kidney Disease Outcomes Quality Initiative Guidelines.
DESCRIPTION STAGE GFR (mL/min/1.73 m²) Slight kidney damage with normal or increased filtration (high GFR). 1 More Than 90 Mild decrease in kidney function (GFR). 2 60-89 Moderate decrease in kidney function (GFR). 3 30-59 Severe decrease in kidney function (GFR). 4 15-29 Kidney failure requiring dialysis or transplantation. 5 Less than 15
CONGENITAL & ACQUIRED KIDNEY DISEASE
People can have two types of kidney disease: congenital, which exist from birth, or acquired, which develop over time. Most patients that visit transplant centers have acquired and chronic kidney diseases. The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. According to the National Kidney Foundation, 20 million Americans, 1 in 9 US adults, have chronic kidney diseases. Another 20 million are at increased risk.
Congenital Kidney Disease Include:
- Congenital hydronephrosis.
- Congenital obstruction of urinary tract.
- Duplicated ureter.
- Horseshoe kidney - Horseshoe kidney affects about 1 in 500 to 1 in 600 people. The persons two kidneys fuse together to form a horseshoe-shape. This is the most common type of fusion anomaly in the kidneys.
- Polycystic kidney disease - A person with polycystic kidney disease has multiple cysts in both kidneys. Symptoms include high blood pressure, fatigue, mild to severe back pain and urinary tract infections.
- Renal dysplasia.
- Unilateral small kidney.
Acquired Kidney Diseases Include:
- Diabetic nephropathy.
- Hydronephrosis is the enlargement of one or both of the kidneys caused by obstruction of the flow of urine.
- Interstitial nephritis.
- Kidney stones are a relatively common and particularly painful disorder.
- Kidney tumors.
- Lupus nephritis.
- Minimal change disease.
- In nephrotic syndrome, the glomerulus has been damaged so that a large amount of protein in the blood enters the urine. Other frequent features of the nephrotic syndrome include swelling, low serum albumin, and high cholesterol.
- Pyelonephritis is infection of the kidneys and is frequently caused by complication of a urinary tract infection.
- Renal failure.
KIDNEY (RENAL) FAILURE GENERAL DESCRIPTION
Kidney failure occurs when the kidneys partly or completely lose their ability to filter water and waste from the blood. The build up of toxic substances normally removed from the body by the kidneys can cause dangerous health problems. Acute kidney failure (also referred to as renal failure) happens rapidly. Mild kidney dysfunction is often called renal insufficiency. Acute kidney failure occurs in about 5 percent of people who are hospitalized for any reason. It is even more common in those receiving intensive care. Chronic kidney failure results when a disease slowly destroys your kidneys. Destruction occurs over many years, usually with no symptoms until the late stage of kidney failure. Progression may be so gradual that symptoms may not occur until kidney function is less than one-tenth of normal.
ACUTE RENAL FAILURE (ARF)
Acute renal failure is the sudden loss of kidney function. It occurs when the kidneys stop working over a period of hours, days, or in some cases, weeks. The kidneys carry out the crucial task of filtering body wastes and maintaining electrolyte levels in the blood. Malfunction of the kidneys could lead to accumulation of waste products, fluids, and electrolytes in the body, which could gravely endanger life. Acute renal failure is also referred clinically as a sharp increase in the serum creatinine level from the baseline (i.e., an increase of at least 0.5 mg/dL) and the urine output is less than 400 ml per day (oliguria), though not strictly applicable for ARF. Acute renal failure is the cause of complications in 5 percent of all hospital admissions. With the exclusion of relevant medical conditions, the mortality rate for ARF stands at 10 percent. The prognosis may be bleak if ARF is accompanied with complicated medical conditions or surgical conditions. Acute renal failure is often the consequence of any untoward experience the body is subjected to; for instance - blood loss due to surgery or medicine (drug) overdose or any injury to the body.
CHRONIC RENAL FAILURE
Chronic renal failure is a gradual and progressive loss of the ability of the kidneys to function normally. The change is irreversible and is due to loss of nephrons of the kidney. The nephrons are basic functioning unit of the kidney and there are normally about one million nephrons in each kidney. The kidney is no longer able to clean toxins and waste product from the blood and concentrates the urine. When patients begin to experience symptoms of kidney failure, most of their kidney function is lost. It can simply be interpreted as the kidneys gradually stop working.
COMMON TYPES OF KIDNEY DISEASE
CHRONIC KIDNEY DISEASE (CKD)
Chronic kidney disease is often the consequence of long term illness like high blood pressure (hypertension) or diabetes which gradually takes a toll on the kidneys, causing them to malfunction. BRIGHT'S DISEASE
Bright's disease is a kidney disease marked by the presence of blood protein in the urine, along with hypertension and edema (retention of water in the tissues).
Glomerulonephritis is an inflammation of tiny blood vessels within the kidney that filter out wastes from the blood. This may occur as result of an immunological response to infection, such as Streptococcus throat infection.
Pyelonephritis is a kidney infection that may be caused by a birth defect. both glomerulonephritis and pyelonephritis can be chronic or acute, and can be serious.
Hydronephrosis is a condition in which the kidney and the renal pelvis (the structure into which the urine is discharged from the kidney) become filled with urine due to an obstruction of urinary flow.
POLYCYSTIC KIDNEY DISEASE (PKD)
Polycystic kidney disease is an inherited disease in which cysts grow on the kidneys, rendering them incapable of functioning. The above specimen shows two grossly enlarged kidneys removed from a patient with adult polycystic kidney disease.
Kidney stones (renal stones) are gravel-like mineral accumulations (primarily calcium) in the kidneys or any area of the urinary system. They can be found anywhere from the kidney to the bladder. They may be large or small, single or multiple in number. Kidney stones result when urine becomes too concentrated, and substances in the urine crystallize to form stones. Symptoms occur when the stones begin to move down the ureter and cause intense pain. Kidney stones may form in the pelvis or calyces of the kidney or in the ureter. Kidney stones occur in 10 to 40 percent of gout patients, and can occur at any time after the development of hyperuricemia. Although the stones are usually composed of uric acid, they may also be mixed with other materials. A 2003 study showed that although a current diagnosis of gout doubles the risk of kidney stones, a history of gout does not increase kidney stone risk. Therefore, reducing gout risk factors with dietary and other lifestyle changes may reduce the likelihood of stone formation.
MoonDragon's Health & Wellness: Gout
MoonDragon's Health & Wellness: Kidney Stones
RENAL TUBULAR ACIDOSIS
In renal tubular acidosis, the kidneys fail to reabsorb bicarbonate normally, causing impaired ammonia production and acid excretion. Severe acidosis, potassium depletion, and bone disorders may result.
Nephrotic syndrome is not a disease in itself, but can be a sign of kidney disease. It is marked by edema and excess protein in the urine. It can be caused by lesions of glomeruli (small structures in the kidney made of capillaries) that become inflamed, or by chronic diseases such as diabetes or lupus.
URINARY TRACT INFECTION (UTI)
Infections of the urinary tract are common. Urinary tract infections are caused by bacteria that invade the urinary system and multiply, leading to an infection. Women are affected more than men. The urinary tract consists of the kidneys, ureters, bladder, and urethra. The key elements in the system are the kidneys, a pair of purplish-brown organs located below the ribs toward the middle of the back. The kidneys remove liquid waste from the blood in the form of urine, keep a stable balance of salts and other substances in the blood, and produce a hormone that aids the formation of red blood cells. Narrow tubes called ureters carry urine from the kidneys to the bladder, a triangle-shaped chamber in the lower abdomen. Urine is stored in the bladder and emptied through the urethra. There are three types of urinary tract infections:
- Urethritis is infection of the urethra.
- Cystitis is infection of the bladder.
- Pyelonephritis occurs when bacteria ascend up the ureters and infect the kidneys.
SIGNS & SYMPTOMS
The kidneys are remarkable in their ability to compensate for problems in their function. Chronic kidney disease may progress without symptoms for a long time until only very minimal kidney function is left.
Because the kidneys perform so many functions for the body, kidney disease can affect the body in a large number of different ways. Symptoms vary greatly. Several different body systems may be affected. Notably, most patients have no decrease in urine output even with very advanced chronic kidney disease.
One important symptom of kidney problems is edema. Edema results when the kidneys produce less urine because they are unable to properly excrete salt and other wastes, and fluid builds up in the body. Ankles and hands may swell, and the person becomes short of breath. Toxic wastes may accumulate in the bloodstream due to kidney malfunction, a condition known as uremia.
TYPES OF EDEMA
- Anasarca Edema: Generalized swelling all over the body.
- Dependent or Peripheral Edema: Swelling in the feet, ankles, and legs.
- Peri-orbital Edema: Swelling around the eyes.
- Corneal Edema (Corneal Stroma): Swelling in the cornea of the eye.
- Preeclampsia: A condition that occurs in 5 percent of pregnant women that results in high blood pressure, edema (fluid accumulation in the tissues) and protein (albuminuria) in the urine. For more information see:
MoonDragon's Health & Wellness: Edema
MoonDragon's Pregnancy Information: Preeclampsia-Eclampsia-Toxemia
PITTING EDEMA VS NON-PITTING EDEMA
Pitting edema can be demonstrated by applying pressure to, for example, the skin of a swollen leg or foot, by depressing the skin with a finger. If the pressing causes an indentation in the skin that persists for some time after the release of the pressure, the edema is referred to as pitting edema. Actually, any form of pressure, such as from the elastic part of socks, can induce the pitting of this edema.
In non-pitting edema, which usually affects the legs or arms, pressure that is applied to the skin does not result in a persistent indentation. Non-pitting edema can occur in certain disorders of the lymphatic system such as lymphedema, which is a disturbance of the lymphatic circulation that may occur after a radical mastectomy, or congenital lymphedema. Another cause of non-pitting edema of the legs is called pretibial myxedema, which is a swelling over the shins that occurs in some patients with hypothyroidism (underactive thyroid gland). Non-pitting edema of the legs is difficult to treat. Diuretic medications are generally not effective, although elevation of the legs periodically during the day and compressive devices may reduce the swelling.
Pitting edema is caused by either systemic diseases, that is, diseases that affect the various organ systems of the body, or by local conditions involving just the affected extremities. The most common systemic diseases that are associated with edema involve the heart, liver, and kidneys. In these diseases, edema occurs primarily because of the body's retention of too much salt (which is the chemical compound sodium chloride). The excess salt holds excess water in the interstitial tissue spaces, where the retained surplus of fluid is recognized as edema. Idiopathic (of unknown cause) edema, also sometimes called cyclical edema, occurs most often in women and just prior to each menstrual period. The most common local conditions that cause edema are varicose veins and thrombophlebitis (a blood clot with inflammation of the veins) of the deep veins of the legs. These conditions can cause inadequate pumping of the blood by the veins (venous insufficiency). The resulting increased back-pressure in the veins forces fluid to leak into the interstitial tissue spaces, where the retained excess fluid is recognized as edema.
KIDNEY PROBLEM SYMPTOMS
Symptoms of kidney problems include:
- Fatigue and weakness (from anemia or accumulation of waste products in the body).
- Abdominal pain.
- Appetite loss.
- Nausea and vomiting.
- Back pain may be sudden and intense, occurring just above the waist and running down the groin.
- Numbness in the feet or hands (peripheral neuropathy).
- Disturbed sleep and restless legs syndrome.
- Altered mental status (encephalopathy from the accumulation of waste products or urinary poisons).
- Fluid retention (bloating), edema causing swelling in the legs and puffiness around the eyes.
- Shortness of breath from fluid in the lungs.
- High blood pressure.
- Chest pain due to pericarditis (inflammation around the heart).
- Urinary urgency. Need to urinate frequently, especially at night.
- Itching, easy bruising, and pale skin (from anemia).
- Bleeding (poor blood clotting).
- The Urine may be cloudy or bloody in appearance.
- Decreased sexual interest and erectile dysfunction.
ACUTE KIDNEY FAILURE SYMPTOMS
The following symptoms may occur with acute kidney failure. Some people have no symptoms, at least in the early stages. The symptoms may be very subtle.
- Decreased urine production.
- Body swelling.
- Problems concentrating.
- Nausea, vomiting.
- Abdominal pain.
- Metallic taste in the mouth.
- Seizures and coma may occur in very severe acute kidney failure.
CHRONIC KIDNEY DISEASE CAUSES
Although chronic kidney disease sometimes results from primary diseases of the kidneys themselves, the major causes are diabetes and high blood pressure.
- Type 1 and type 2 diabetes mellitus cause a condition called diabetic nephropathy, which is the leading cause of kidney disease in the United States. See Diabetes for more information.
- High blood pressure (hypertension), if not controlled, can damage the kidneys over time. See Hypertension for more information.
- Glomerulonephritis is the inflammation and damage of the filtration system of the kidneys and can cause kidney failure. Post-infectious conditions and lupus are among the many causes of glomerulonephritis. See Lupus for more information.
- Polycystic kidney disease is an example of a hereditary cause of chronic kidney disease wherein both kidneys have multiple cysts.
- Use of analgesics such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) regularly over long durations of time can cause analgesic nephropathy, another cause of kidney disease. Certain other medications can also damage the kidneys.
- Clogging and hardening of the arteries (atherosclerosis) leading to the kidneys causes a condition called ischemic nephropathy, which is another cause of progressive kidney damage.
- Obstruction of the flow of urine by stones, an enlarged prostate, strictures (narrowings), or cancers may also cause kidney disease.
- Other causes of chronic kidney disease include HIV infection, sickle cell disease, heroin abuse, amyloidosis, kidney stones, chronic kidney infections, and certain cancers.
ACUTE KIDNEY FAILURE CAUSES
Causes of acute kidney failure fall into one of the following categories:
- Pre-Renal: Problems affecting the flow of blood before it reaches the kidneys.
- Post-Renal: Problems affecting the movement of urine out of the kidneys.
- Renal: Problems with the kidney itself that prevent proper filtration of blood or production of urine.
Pre-renal failure is the most common type of acute renal failure (60 to 70 percent of all cases). The kidneys do not receive enough blood to filter. Pre-renal failure can be caused by the following conditions:
- Dehydration: - From vomiting, diarrhea, water pills, or blood loss.
- Disruption of blood flow to the kidneys from a variety of causes:
- Drastic drop in blood pressure from major surgery with blood loss, severe injury or burns, or infection in the bloodstream (sepsis) causing blood vessels to inappropriately relax.
- Blockage or narrowing of a blood vessel carrying blood to the kidneys.
- Heart failure or heart attacks causing low blood flow.
- Liver failure causing changes in hormones that affect blood flow and pressure to the kidney.
There is no actual damage to the kidneys early in the process with pre-renal failure. With appropriate treatment, the dysfunction usually can be reversed. Prolonged decrease in the blood flow to the kidneys, for whatever reason, can however cause permanent damage to the kidney tissues.
Post-renal failure is sometimes referred to as obstructive renal failure, since it is often caused by something blocking elimination of urine produced by the kidneys. It is the rarest cause of acute kidney failure (5 to 10 percent of all cases). This problem can be reversed, unless the obstruction is present long enough to cause damage to kidney tissue.
Obstruction of one or both ureters can be caused by the following:
- Kidney stone, usually only on one side.
- Cancer of the urinary tract organs or structures near the urinary tract that may obstruct the outflow of urine.
Obstruction at the bladder level can be caused by the following:
- Bladder stone.
- Enlarged prostate (the most common cause in men).
- Blood clot.
- Bladder cancer.
- Neurologic disorders of the bladder impairing its ability to contract.
Treatment consists of relieving the obstruction. Once the blockage is removed, the kidneys usually recover in one to two weeks if there is no infection or other problem.
Primary renal damage is the most complicated cause of renal failure (accounts for 25 to 40 percent of cases). Renal causes of acute kidney failure include those affecting the filtering function of the kidney, those affecting the blood supply within the kidney, and those affecting the kidney tissue that handles salt and water processing.
Some kidney problems that can cause kidney failure include:
- Blood vessel diseases.
- Blood clot in a vessel in the kidneys.
- Injury to kidney tissue and cells.
- Acute interstitial nephritis.
- Acute tubular necrosis.
- Glomerulonephritis: The glomeruli, the initial filtration system in the kidney, can be damaged by a variety of diseases, including infections. The resulting inflammation impairs kidney function. A common example is strep throat. Streptococcal bacterial infections may damage the glomeruli. Glomerular disorder symptoms may include dark-colored urine (like cola or tea) and back pain. Other symptoms include producing less urine than usual, blood in the urine, high blood pressure, and body swelling (retaining water). Treatment usually consists of medications and, if kidney function fails significantly, dialysis may be needed to remove life-threatening waste products that cannot be excreted.
- Acute Interstitial Nephritis: This is a sudden decline in kidney function caused by inflammation of interstitial kidney tissue which primarily handles salt and water balance rather than the filtering of wastes. Medications such as antibiotics, anti-inflammatory medicines (for example, aspirin, ibuprofen), and water pills (diuretics) are the most common causes. Other causes include infections and immune-related diseases such as lupus, leukemia, lymphoma, and sarcoidosis. It is usually reversible if the kidney damage is not severe. Treatment consists of withdrawal of offending drugs, treatment of infection, and dialysis in cases of very low kidney function.
- Acute Tubular Necrosis: The kidney tubules are damaged and do not function normally. Tubular necrosis is usually the end result from the other causes of acute renal failure. The tubules are delicate structures that handle much of the kidney's filtration function. When there is necrosis, the cells that form the tubules become dysfunctional and "die". This condition accounts for 90 percent of cases of primary acute kidney failure. Causes include shock (decreased blood supply to the kidneys), drugs (especially antibiotics) and chemotherapy agents, toxins and poisons, and dyes used in certain kinds of x-rays. Some people produce much less urine than usual. Other symptoms of acute tubular necrosis include tiredness, swelling, lethargy, nausea, vomiting, abdominal pain, loss of appetite, and rash. Sometimes there are no symptoms. Treatment depends on the cause of the damage and may consist of discontinuing problem medications, replenishing body fluids, and improving blood flow to the kidney. A diuretic may be given to increase urine production if the total body water level is too high. Medications may be given to correct blood chemistry imbalances. If there is no recovery of the patient's kidneys and these treatments do not sufficiently substitute for the lost kidney function, the patient will need regular dialysis or may be a candidate for kidney transplantation.
CHRONIC RENAL DISEASE
If you have any of the following conditions, you are at higher-than-normal risk of developing chronic renal disease. Your kidney functions may need to be monitored regularly.
- Diabetes mellitus type 1 or 2.
- High blood pressure (hypertension).
- High cholesterol.
- Heart disease.
- Liver disease.
- Kidney disease.
- Sickle cell disease.
- Systemic Lupus erythematosus.
- Vascular diseases such as arteritis, vasculitis, or fibromuscular dysplasia.
- Vesicoureteral reflux (a urinary tract problem in which urine travels the wrong way).
- Problems of the joints or muscles that require regular use of anti-inflammatory medications.
- If you have a family history of kidney disease.
Chronic kidney disease is a growing health problem in the United States. A report by the Centers for Disease Control (CDC) determined that 16.8 percent of all adults above the age of 20 years have chronic kidney disease. Thus, one in six individuals have kidney disease, and over 400,000 patients are on dialysis or have received kidney transplants. About 67,000 people die each year because of kidney failure.
The prevalence of chronic kidney disease has increased by 16 percent from the previous decade. The increasing incidence of diabetes mellitus, hypertension (high blood pressure), obesity, and an aging population have led to this increase in kidney disease. Chronic kidney disease is more prevalent among individuals above 60 years of age (39.4 percent). Kidney disease is more common among Hispanic, African American, Asian or Pacific Islander, and Native American people.
Chronic kidney disease cannot be prevented in most situations. You may be able to protect your kidneys from damage, or slow the progression of the disease by controlling your underlying conditions.
Kidney disease is usually advanced by the time symptoms appear. If you are at high risk of developing chronic kidney disease, see your health care provider as recommended for screening tests.
If you have a chronic condition such as diabetes, high blood pressure, or high cholesterol, follow the treatment recommendations of your health care provider. See your health care provider regularly for monitoring. Aggressive treatment of these diseases is essential.
Avoid exposure to drugs especially NSAIDs (non-steroidal anti-inflammatory drugs), chemicals, and other toxic substances as much as possible.
EXAMS & TESTS FOR CHRONIC KIDNEY DISEASE
Chronic kidney disease usually causes no symptoms in its early stages. Only lab tests can detect any developing problems. Anyone at increased risk for chronic kidney disease should be routinely tested for development of this disease. Urine, blood, and imaging tests (x-rays) are used to detect kidney disease, as well as to follow its progress. All of these tests have limitations. They are often used together to develop a picture of the nature and extent of the kidney disease. In general, this testing can be performed on an outpatient basis.
- Urinalysis: Analysis of the urine affords enormous insight into the function of the kidneys. The first step in urinalysis is doing a dipstick test. The dipstick has reagents that check the urine for the presence of various normal and abnormal constituents including protein. Then, the urine is examined under a microscope to look for red and white blood cells, and the presence of casts and crystals (solids).
Only minimal quantities of albumin (protein) are present in urine normally. A positive result on a dipstick test for protein is abnormal. More sensitive than a dipstick test for protein is a laboratory estimation of the urine albumin (protein) and creatinine in the urine. The ratio of albumin (protein) and creatinine in the urine provides a good estimate of albumin (protein) excretion per day.
- 24-hour Urine Tests: This test requires you to collect all of your urine for 24 consecutive hours. The urine may be analyzed for protein and waste products (urea, nitrogen, and creatinine). The presence of protein in the urine indicates kidney damage. The amount of creatinine and urea excreted in the urine can be used to calculate the level of kidney function and the glomerular filtration rate (GFR).
- Glomerular Filtration Rate (GFR): The GFR is a standard means of expressing overall kidney function. As kidney disease progresses, GFR falls. The normal GFR is about 100-140 mL/min in men and 85-115 mL/min in women. It decreases in most people with age. The GFR may be calculated from the amount of waste products in the 24-hour urine or by using special markers administered intravenously. Patients are divided into five stages of chronic kidney disease based on their GFR (see GFR Stage Table above).
- Serum Creatinine & Blood Urea (BUN): Blood urea nitrogen and serum creatinine are the most commonly used blood tests to screen for, and monitor renal disease. Creatinine is a breakdown product of normal muscle breakdown. Urea is the waste product of breakdown of protein. The level of these substances rises in the blood as kidney function worsens.
- Estimated GFR (eGFR): The laboratory or your health care provider may calculate an estimated GFR using the information from your blood work. It is important to be aware of your estimated GFR and stage of chronic kidney disease. Your health care provider uses your stage of kidney disease to recommend additional testing and suggestions on management.
- Electrolyte Levels & Acid-Base Balance: Kidney dysfunction causes imbalances in electrolytes, especially potassium, phosphorus, and calcium. High potassium (hyperkalemia) is a particular concern. The acid-base balance of the blood is usually disrupted as well.
Decreased production of the active form of vitamin D can cause low levels of calcium in the blood. Inability to excrete phosphorus by failing kidneys causes its levels in the blood to rise. Testicular or ovarian hormone levels may also be abnormal.
- Blood Cell Counts: Because kidney disease disrupts blood cell production and shortens the survival of red cells, the red blood cell count and hemoglobin may be low (anemia). Some patients may also have iron deficiency due to blood loss in their gastrointestinal system. Other nutritional deficiencies may also impair the production of red cells.
EXAMS & TESTS FOR ACUTE RENAL FAILURE
Many people with acute renal failure notice no symptoms. Even with symptoms, they are non-specific, meaning they could be caused by many different conditions. A physical examination typically reveals few, if any, abnormal findings.
Kidney failure is often detected from blood or urine tests. These tests might be ordered because the patient is in the hospital for another reason, because they don't feel well and can't tell why, or as part of a routine health screening.
Levels of urea (blood urea nitrogen [BUN]) and creatinine are high in kidney failure of pre-renal origin. This is called azotemia.
Electrolyte levels in the blood may be abnormally high or low because of improper filtering.
When the duration and severity of kidney failure is severe, the red blood cell count may be low. This is called anemia.
The amount of urine produced over a period of hours may also be measured for quantity and quality or the amount of wastes being excreted. When kidney tissue is injured, protein and desirable substances may be inappropriately excreted in the urine. In some cases, the amount of urine remaining in the bladder after urination will be measured by inserting a catheter (a thin, rubber tube) that drains the bladder.
Urine retained in the bladder after urinating suggests post-renal failure, usually due to prostate enlargement in men. The urine may be dark, indicating that creatinine and other substances are concentrated.
The urine will be examined under a microscope to detect signs of specific kidney problems. Some of these signs include blood, pus, and solid materials called casts.
Electrolyte levels in the urine may help pinpoint the exact cause of the kidney failure. If the diagnosis is not certain after laboratory tests, an ultrasound of the kidneys and bladder may be done. These can help reveal signs of specific causes of kidney failure.
In some cases, tissue samples of the kidneys are taken (biopsy) to find the cause of the renal failure.
Ultrasound: Ultrasound is often used in the diagnosis of kidney disease. An ultrasound is a non-invasive type of test. In general, kidneys are shrunken in size in chronic kidney disease, although they may be normal or even large in size in cases caused by adult polycystic kidney disease, diabetic nephropathy, and amyloidosis. Ultrasound may also be used to diagnose the presence of urinary obstruction, kidney stones and also to assess the blood flow into the kidneys.
Biopsy: A sample of the kidney tissue (biopsy) is sometimes required in cases in which the cause of the kidney disease is unclear. Usually, a biopsy can be collected with local anesthesia only by introducing a needle through the skin into the kidney. This is usually done as an outpatient procedure, though some institutions may require an overnight hospital stay.
CONVENTIONAL MEDICAL TREATMENT
CHRONIC KIDNEY DISEASE TREATMENT - SELF-CARE AT HOME
Chronic kidney disease is a disease that must be managed in close consultation with your health care provider. Self-treatment is not appropriate. There are, however, several important dietary rules you can follow to help slow the progression of your kidney disease and decrease the likelihood of complications. This is a complex process and must be individualized, generally with the help of your health care provider and a registered dietitian. The following are general dietary guidelines:
- Protein Restriction: Decreasing protein intake may slow the progression of chronic kidney disease. A dietitian can help you determine the appropriate amount of protein for you.
- Salt Restriction: Limit to 4-6 grams a day to avoid fluid retention and help control high blood pressure.
- Fluid Intake: Excessive water intake does not help prevent kidney disease. In fact, your health care provider may recommend restriction of water intake.
- Potassium Restriction: This is necessary in advanced kidney disease because the kidneys are unable to remove potassium. High levels of potassium can cause abnormal heart rhythms. Examples of foods high in potassium include bananas, oranges, nuts, and potatoes.
- Phosphorus Restriction: Decreasing phosphorus intake is recommended to protect bones. Eggs, beans, cola drinks, and dairy products are examples of foods high in phosphorus.
Other important measures that you can take include:
- Carefully follow prescribed regimens to control your blood pressure and/or diabetes.
- Stop smoking.
- Lose excess weight.
In chronic kidney disease, several medications can be toxic to the kidneys and may need to be avoided or given in adjusted doses. Among over-the-counter medications, the following need to be avoided or used with caution:
- Certain Analgesics: Aspirin; non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen [Motrin, for example]).
- Fleets or Phosphosoda Enemas: Because of their high content of phosphorus.
- Laxatives & Antacids: Those containing magnesium and aluminum such as Milk of Magnesia and Mylanta.
- Ulcer Medication H2-Receptor Antagonists: cimetidine (Tagamet), ranitidine (Zantac), (decreased dosage with kidney disease).
- Decongestants: Like pseudoephedrine (Sudafed) especially if you have high blood pressure.
- Alka Seltzer: Since this contains a lot of salt.
- Herbal Medications: If you have a condition such as diabetes, high blood pressure, or high cholesterol underlying your chronic kidney disease, take all medications as directed and see your health care provider as recommended for follow-up and monitoring.
ACUTE KIDNEY FAILURE TREATMENT - SELF-CARE AT HOME
Self-treatment of acute kidney failure is not recommended. Kidney failure can be a very serious condition that requires medical care. It may be possible to receive some or all treatment at home. Treatment in some cases can be administered by a home health nurse under the supervision of a health care provider.
In cases in which recovery of kidney function is incomplete, the artificial kidney may be needed to clear excess water and accumulating wastes. This is done by dialysis, a process by which the blood is cleared of wastes and excess water. Dialysis, when needed for acute renal failure, is performed at a hospital or dialysis center. Home dialysis may be appropriate in cases in which kidney failure is permanent and dialysis is needed indefinitely.
CHRONIC KIDNEY DISEASE MEDICAL TREATMENT
There is no cure for chronic kidney disease. The four goals of therapy are as follows:
- To slow the progression of disease.
- To treat underlying causes and contributing factors.
- To treat complications of disease.
- To replace lost kidney function.
Strategies for slowing progression and treating conditions underlying chronic kidney disease include the following:
- Control Of Blood Glucose: Maintaining good control of diabetes is critical. People with diabetes who do not control their blood glucose have a much higher risk of all complications of diabetes, including chronic kidney disease.
- Control Of High Blood Pressure: This also slows progression of chronic kidney disease. It is recommended to keep your blood pressure below 130/80 mm Hg if you have kidney disease. It is often useful to monitor blood pressure at home. Blood pressure medications known as angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) have special benefit in protecting the kidneys.
- Diet: Diet control is essential to slowing progression of chronic kidney disease and should be done in close consultation with your health care provider and a dietitian.
The complications of chronic kidney disease may require medical treatment.
- Fluid retention can be treated with any of a number of diuretic medications, which remove excess water from the body. However, these drugs are not suitable for all patients.
- Anemia can be treated with erythropoiesis stimulating agents. Erythropoiesis stimulating agents are a group of drugs that replace the deficiency of erythropoietin, which is normally produced by healthy kidneys. Often, patients treated with such drugs require either to take iron by mouth or sometimes even intravenously.
- Bone disease develops in patients due to an inability to excrete phosphorus and a failure to form activated Vitamin D. In such circumstances, your physician may prescribe drugs binding phosphorus in the gut, and may prescribe active forms of vitamin D.
- Acidosis may develop with kidney disease. The acidosis may cause breakdown of proteins, inflammation and bone disease. If the acidosis is significant, your health care provider may use drugs such as sodium bicarbonate (baking soda) to correct the problem.
ACUTE KIDNEY FAILURE MEDICAL TREATMENT
Treatment of acute renal failure depends partly on the cause and extent of the failure. The patient should be referred to a kidney specialist (nephrologist) for care. The first goal is to pinpoint the exact cause of the kidney failure, as that will partly dictate the treatment. Secondly, the degree to which accumulating wastes and water are affecting the body will impact treatment decisions about medications and the need for dialysis.
Medical treatment is focused on removing the cause of the kidney failure.
Medications and other products the patient ingests will be reviewed. Any that might harm the kidneys will be eliminated or the dose reduced.
Other treatments will be offered, with the following goals:
- Correct Dehydration: Intravenous fluids, with electrolyte replacement if needed.
- Fluid Restriction: For those types of kidney failure in which excess fluid is not appropriately eliminated by the kidneys.
- Increase Blood Flow To The Kidney: Usually related to improving heart function or increasing blood pressure.
- Correct Chemical (Electrolyte) Abnormalities: Keeps other body systems working properly.
If the patient's kidneys do not respond to treatment, and adequate kidney function does not return, they will need to undergo dialysis. Dialysis is done by accessing the blood vessels through the skin (hemodialysis) or by accessing the abdominal cavity through the lining that encases the abdominal organs (peritoneal dialysis).
With hemodialysis, the patient is connected to a machine by a tube running from a conduit created surgically between a large artery and vein. Blood is circulated through the artificial kidney, which removes toxins and wastes. The blood is then returned to the patient's body.
Most people require hemodialysis three times per week.
With peritoneal dialysis, wastes and excess water from the bloodstream cross into the abdominal cavity (peritoneal space) and are eliminated from the body by coursing through a catheter that is surgically implanted (through the skin) into the peritoneal cavity.
Most people with acute kidney failure improve when the cause of the kidney failure is removed or treated and do not require dialysis. Normal kidney function is usually restored, though in some cases, residual damage only allows partial restoration of the kidney function. Such patients may not require dialysis but may need medicines to supplement lost kidney function.
In end-stage renal disease, kidney functions can be replaced only by dialysis or by kidney transplantation. There are two types of dialysis (1) hemodialysis and (2) peritoneal dialysis.
Hemodialysis involves circulation of blood through a filter on a dialysis machine. Blood is cleansed of waste products and excess water. The acid levels and the concentration of various minerals such as sodium and potassium in the blood are normalized. The blood is then returned to the body.
Long-term dialysis requires access to a blood vessel so that the machine has a way to remove and return blood to the body. This may be in the form of a dialysis catheter or an arteriovenous fistula or graft. A catheter may be either temporary or permanent. These catheters are either placed in the neck or the groin into a large blood vessel. These catheters are prone to infection and may also cause blood vessels to clot or narrow. The preferred access for hemodialysis is an arteriovenous fistula wherein an artery is directly joined to a vein. The vein takes two to four months to enlarge and mature before it can be used for dialysis. Once matured, two needles are placed into the vein for dialysis. One needle is used to draw blood and run through the dialysis machine. The second needle is to return the cleansed blood. An arteriovenous graft is placed in patients who have small veins or in whom a fistula has failed to develop. The graft is made of artificial material and the dialysis needles are inserted into the graft directly. These venous access devices usually can be placed with local anesthesia on an outpatient basis.
Hemodialysis typically takes three to five hours and is needed three times a week. You will need to travel to a dialysis center for hemodialysis. Home hemodialysis is possible in some situations. A care partner is needed to assist you with the dialysis treatments. A family member or close friend are the usual options, though occasionally patients may hire a professional to assist with dialysis. Home hemodialysis may be performed as traditional three times a week treatments, long nocturnal (overnight) hemodialysis, or short daily hemodialysis. Daily hemodialysis and long nocturnal hemodialysis offer advantages in quality of life and better control of high blood pressure, anemia, and bone disease.
Peritoneal dialysis utilizes the lining membrane (peritoneum) of the abdomen as a filter to clean blood and remove excess fluid. A catheter is implanted into the abdomen by a minor surgical procedure. Peritoneal dialysis may be performed manually or by using a machine to perform the dialysis at night. About 2 to 3 liters of dialysis fluid are infused into the abdominal cavity through this catheter. This fluid contains substances that pull wastes and excess water out of neighboring tissues. The fluid is allowed to dwell for two to several hours before being drained, taking the unwanted wastes and water with it. The fluid typically needs to be exchanged four to five times a day.
Peritoneal dialysis offers much more freedom compared to hemodialysis since patients do not need to come to a dialysis center for their treatment. You can carry out many of your usual activities while undergoing this treatment. This may be the preferable therapy for children.
Most patients are candidates for both hemodialysis and peritoneal dialysis. There are little differences in outcomes between the two procedures. Your health care provider may recommend one kind of dialysis over the other based on your medical and surgical history. It is best to choose your modality of dialysis after understanding both procedures and matching them to your life style, daily activities, schedule, distance from the dialysis unit, support system, and personal preference.
Laparoscopic Nephrectomy: The kidney is removed using laparoscopic instruments under general anesthesia. Small one inch incisions are made in the patient's abdomen.
Kidney Resection: A portion of a person's kidney is surgically removed usually because they have a cancerous tumor. This procedure can help that person regain normal functioning of their kidneys. It can also help prevent the need for dialysis.
Kidney Transplant: A kidney transplant is an operation in which a person whose own kidneys have failed receives a new kidney to take over the work of cleaning the blood. There are two types of kidney transplants - those that come from living donors and those that come from unrelated donors who have died (non-living donors).
Kidney transplantation offers the best outcomes and the best quality of life. Successful kidney transplants occur every day in the United States. Transplanted kidneys may come from living related donors, living unrelated donors, or people who have died of other causes (cadaveric donors). In people with type I diabetes, a combined kidney-pancreas transplant is often a better option.
However, not everyone is a candidate for kidney transplant. Patients need to undergo extensive testing to ensure their suitability for transplantation. Also, there is a shortage of organs for transplantation, requiring patients to wait months to years before getting a transplant.
A person who needs a kidney transplant undergoes several tests to identify characteristics of his or her immune system. The recipient can accept only a kidney that comes from a donor who matches certain of his or her characteristics. The more similar the donor is in these characteristics, the greater the chance of long-term success of the transplant. Transplants from a living related donor generally have the best results.
Transplant surgery is a major procedure and generally requires four to seven days in the hospital. All transplant recipients require lifelong immunosuppressant medications to prevent their bodies from rejecting the new kidney. Immunosuppressant medications require careful monitoring of blood levels and increase the risk of infection as well as some types of cancer.
FOLLOW-UP CARE WITH YOUR HEALTH CARE PROVIDER
FOLLOW-UP CHRONIC KIDNEY DISEASE
If you have chronic kidney disease, your health care provider will recommend a schedule of regular follow-up visits. At these visits, your underlying condition and your kidney status will be evaluated. You will have regular blood and urine tests and possibly imaging studies as part of this ongoing evaluation.
FOLLOW-UP RENAL FAILURE
The patient's health care provider will arrange follow-up visits as needed for the underlying cause of their kidney failure and the severity of the disease. He or she will monitor the patient's underlying condition and do appropriate lab tests to be sure that the kidney failure has resolved. Preventive measures may be needed in some situations to prevent the problem from occurring again.
CHRONIC KIDNEY DISEASE
There is no cure for chronic kidney disease. The natural course of the disease is to progress until dialysis or transplant is required. Patients with chronic kidney disease are at a much higher risk than the general population to develop strokes and heart attacks.
People undergoing dialysis have an overall five year survival rate of 32 percent. The elderly and those with diabetes have worse outcomes.
Recipients of a kidney transplant from a living related donor have a two year survival rate greater than 90 percent.
Recipients of a kidney from a donor who has died have a two year survival rate of 88 percent.
ACUTE KIDNEY FAILURE
Recovery from acute kidney failure depends on what caused the disease. If the cause does not stem from damage to kidney tissue itself, the patient will probably make a full recovery. Partial recovery of function may occur in situations in which the injury does not completely resolve.
CARDIOVASCULAR DISEASE & KIDNEY TRANSPLANT COMPLICATIONS
Jerry McCauley, MD, MPH
Professor of Medicine
Department of Medicine, Renal-Electrolyte Division
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Data from the United States Renal Data System confirm the high incidence of cardiovascular disease (CVD) among renal transplant recipients is nearly twice that of the general population. Compared with the general population, cardiovascular mortality in transplant patients, stratified by age, is increased almost 10-fold between the ages of 35 and 44 years and is at least doubled between the ages of 55 and 64 years.
Death with graft function is a leading cause of graft loss. From the years 1988-1997, the percentage of graft failures caused by patient death was 27.2 percent 1 month after transplantation, 47.3 percent 2 months to 1 year after transplantation, 43.2 percent 13 months to 5 years after transplantation, and 39.9 percent 5 to 10 years after transplantation. CVD was the primary reported cause of death with graft function.
Evaluation of the risk factors for the development of CVD reveals that most kidney transplant patients fall into "very high risk" or "high risk" categories. In the dialysis population (reported values are approximate), pre-existing coronary artery disease (CAD) affects 40 percent of patients, and 50 percent of all mortality is due to CVD; diabetes mellitus affects 40 percent of patients. In the post-transplant population (reported values are approximate) 80 percent of patients are on antihypertensive medications, but blood pressure is still poorly controlled; hyperlipidemia affects greater than 60 percent patients. The optimum blood pressure goal for non-diabetic patients is below 120/80 mm Hg. The goal for patients with diabetes is below 130/80 mmHg. Post-transplant hypertension is defined as blood pressure greater than 140/90 mm Hg or an increase in blood pressure that requires treatment with antihypertensive medication.
Hypertension is associated with decreased graft survival. Patients with the lowest post-transplant blood pressure (less than 120-129 mm Hg) had the best chance of graft survival, and the chance of survival decreased as the blood pressure went up, so patients with the highest blood pressure (180 mm Hg) had the least chance of survival. Opelz and colleagues concluded that post transplant blood pressure is a highly significant predictor of long-term kidney graft survival.
A study by Peschke and coworkers analyzed the relationship between hypertension and renal graft failure (plasma creatinine levels) among kidney transplant recipients maintained on azathioprine monotherapy over a 5-year period with or without antihypertensive therapy. Normotension was defined as blood pressure less than or equal to 140/90 mm Hg and no antihypertensive therapy except diuretics. High blood pressure was defined as blood pressure greater than 160/95 mm Hg and/or on antihypertensive medication. At 1 year post-transplantation, the patients with high blood pressure had significantly higher plasma creatinine levels compared with normotensive patients. This difference was even more pronounced at 3 and 5 years post-transplantation, over which time renal allograft function declined steadily in the hypertensive group (higher plasma creatinine levels) and remained approximately stable in the patients with normal blood pressure (steady plasma creatinine levels).
In a phase 3 trial of kidney transplantation, the results after 5 years suggest that among tacrolimus (TAC)-treated patients, there was a reduced requirement for anti-hypertensives, indicating easier control of blood pressure (80.9 percent of TAC-treated patients requiring antihypertensives versus 91.3 percent of cortisone-treated patients). Vincenti and colleagues suggest that further research is needed to reveal the clinical significance of this finding. Blood pressure control is critical to long-term survival because hypertension is linked to both poor kidney function and the development of chronic allograft nephropathy.
In this study, conducted by Gonwa and colleagues, treatment with TAC plus sirolimus (SRL) was compared with TAC plus mycophenolate mofetil (MMF) to examine the effects of combination drug therapy on blood pressure after kidney transplantation. The investigators concluded that although both the diastolic and systolic blood pressure values remained lower in the TAC + MMF group, the only statistically significant difference was found in diastolic blood pressure at 6 months. Therefore, a combination of TAC plus MMF may be superior in terms of improving cardiovascular risk factors such as hypertension.
The treatment of renal transplant recipients who develop hypertension involves lifestyle modifications (i.e., diet, smoking cessation, weight loss, and exercise), beta-blockers (which may contribute to hyperlipidemia), and loop diuretics (which treat hyperkalemia and fluid retention).
Treatment of hypertension may also involve calcium channel blockers, which lessen vasoconstriction and thereby reduce the nephrotoxicity of calcineurin inhibitors. However, there is a danger of adverse drug interactions, so calcineurin inhibitor blood levels must be monitored and dosages adjusted accordingly. There is also a risk of increased gingival hypertrophy. Angiotensin-converting enzyme inhibitors slow the process of renal failure and improve alternations of the cardiovascular system. They also exert negative side effects such as anemia, hyperkalemia, and renal dysfunction
Although the withdrawal of corticosteroids from the immunosuppressive regimens of renal transplant recipients has been shown to be associated with an increased risk of acute and chronic allograft rejection, especially among black patients, treatment with corticosteroids can increase a patient's blood pressure and need for antihypertensive medications. Hricik and colleagues studied the effects of prednisone withdrawal in 44 black kidney transplant recipients who were treated with a combination of TAC, SRL, and corticosteroids (prednisone). Prednisone was withdrawn as early as 3 months posttransplantation, and patients were followed for a minimum of 9 months posttransplantation. Corticosteroid withdrawal was associated with significant reductions in blood pressure.
There were no significant differences between patients with normal and elevated serum cholesterol levels for the probability of doubling the serum creatinine (SCr) level. SCr levels and the probability of doubling the SCr level were approximately the same in both groups. At 12 months, the probability was 0.15 for patients with hypercholesterolemia vs 0.03 for patients with normal cholesterol levels. At 60 months, the probability was 0.48 for patients with hypercholesterolemia vs 0.08 for patients with normal cholesterol levels. At 120 months, the probability was again 0.48 for patients with hypercholesterolemia vs 0.18 for patients with normal cholesterol. Carvalho and colleagues concluded that hypercholesterolemia was not associated with loss of graft function.
In this study of 198 patients with elevated cholesterol levels, those who had an episode of acute kidney rejection were significantly more likely to lose their kidney grafts than were their counterparts (n = 244) who had an acute rejection episode. The study authors concluded that hypercholesterolemia was an independent risk factor for kidney graft loss due to chronic rejection in male patients who in the first year post-transplantation had experienced 1 or more episodes of acute kidney rejection. Therefore, treatment of hypercholesterolemia may help to reduce kidney graft loss caused by chronic rejection in this group of patients.
Ciancio and colleagues recorded the effects of immunosuppressive agents on cholesterol levels in 150 transplant recipients at 3 months posttransplantation. Results indicated that SRL (especially when combined with cyclosporine [CsA]) markedly raised the cholesterol level of renal transplant recipients, resulting in an increased risk of cardiovascular disease, a very common cause of death after renal transplantation. The TAC/SRL group had a somewhat lesser adverse effect, perhaps due to the protective effect of TAC on the lipid profile.
While the total cholesterol/LDL levels were similar between the TAC group (198/115 mg/dL) and the CsA group (210/118 mg/dL) at 5 years posttransplantation, the percentage of patients who were being treated with antihyperlipidemics was much lower in the TAC group (28 percent) vs the CsA group (58.8 percent). More attention needs to be focused on the lipid profiles of renal transplant recipients.
This multicenter study assessed kidney transplant recipients who developed hypercholesterolemia (total cholesterol more than 240 mg/dL) while being treated with CsA. The value of TAC-based therapy to the lipid profile is underscored by the significant reduction in total cholesterol and LDL cholesterol levels that resulted when the patients were converted to a TAC-based regimen. Reductions in total cholesterol (-55 mg/dL), LDL cholesterol (-48 mg/dL), and apolipoprotein B (-36 mg/dL) at 6 months suggest that TAC was part of an effective treatment strategy for hypercholesterolemia in kidney transplant patients.
Acceptable total cholesterol levels are less than 200 mg/dL with LDL less than or equal to 100 mg/dL and HDL greater than 35 mg/dL. Hyperlipidemia is defined as a total cholesterol level equal to and greater than 200 mg/dL with LDL equal to and greater than 100 mg/dL and HDL equal to or less than 35 mg/dL.
The major classes of antihyperlipidemic agents that have been found to be effective at lipid reduction during the posttransplant treatment period and the potential adverse effects that can limit the use of these agents. Recent research suggests that statins may be the best choice, because they effectively lower lipid levels and are relatively safe to use. It has also been speculated that statins may play a role in the prevention of acute and chronic kidney rejection. Administering hydrophilic statins (e.g., pravastatin, fluvastatin) may reduce the risk of rhabdomyolysis.
Chronic kidney disease is defined as either kidney damage or glomerular filtration rate less than 60 mL/min/1.73 m² for at least or more than 3 months according to the Kidney Disease Outcomes Quality Initiative guidelines.
RECOMMENDATIONS FOR MANAGEMENT OF & TREATMENT GOALS FOR HYPERLIPIDEMIA
The recommendations for management of and treatment goals for hyperlipidemia are as follows:
Triglyceride (TG) less than or equal to 500 mg/dL: the goal is to reduce the level to less than 500 mg/dL through initiation of total lifestyle changes, an increase in fibrate or niacin, or an alternative fibrate or niacin.
LDL 100-159 mg/dL: The goal is to reduce the level to less than 100 mg/dL through initiation of total lifestyle changes, increase in total lifestyle changes plus low-dose statin, with alternative bile acid sequestrant or niacin.
LDL 130 mg/dL: The goal is to reduce the level to less than 100 mg/dL through initiation of total lifestyle changes + a low-dose statin, increase in total lifestyle changes plus maximum-dose statin, with alternative bile acid sequestrant or niacin.
TG 200 mg/dL and non-HDL 130 mg/dL: The goal is to reduce the non-HDL level to less than 130 mg/dL through initiation of total lifestyle changes plus low-dose statin, increase in total lifestyle changes plus a maximum-dose statin, with fibrate or niacin.
Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32(suppl 3):S112-S119.
Ojo AO, Hanson JA, Wolfe RA, Leichtman AB, Agodoa LY, Port FK. Long-term survival in renal transplant recipients with graft function. Kidney Int. 2000;57:307-313. Abstract.
Braun WE, McCauley J. Post-Transplant Outpatient Care. In: Norman DJ, Suki WN, eds. Primer on Transplantation. 1998: 229-244.
Danovitch GM. The epidemic of cardiovascular disease in chronic renal disease: a challenge to the transplant physician. Graft. 1999;2(suppl II):S108-S112.
Chobanian AV, Bakris GL, Black HR, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA. 2003;289:2560-2572. Abstract.
American Diabetes Association. National Diabetes Fact Sheet. 2002.
Opelz G, Wujciak T, Ritz E. Association of chronic kidney graft failure with recipient blood pressure. Collaborative Transplant Study. Kidney Int. 1998;53:217-222. Abstract.
Peschke B, Scheuermann EH, Geiger H, Bolscher S, Kachel HG, Lenz T. Hypertension is associated with hyperlipidemia, coronary heart disease and chronic graft failure in kidney transplant recipients. Clin Nephrol. 1999;51:290-295. Abstract.
Vincenti F, Jensik SC, Filo RS, Miller J, Pirsch J. A long-term comparison of tacrolimus (FK506) and cyclosporine in kidney transplantation: evidence for improved allograft survival at five years. Transplantation. 2002;73:775-782. Abstract.
Gonwa T, Mendez R, Yang HC, et al. Randomized trial of tacrolimus in combination with sirolimus or mycophenolate mofetil in kidney transplantation: results at 6 months. Transplantation. 2003;75:1213-1220. Abstract.
Hricik DE, Knauss TC, Bodziak KA, et al. Withdrawal of steroid therapy in African American kidney transplant recipients receiving sirolimus and tacrolimus. Transplantation. 2003;76:938-942. Abstract.
Carvalho MF, Soares V. Hyperlipidemia as a risk factor of renal allograft function impairment. Clin Transpl. 2001;15:48-52.
Wissing KM, Abramowicz D, Broeders N, Vereerstraeten P. Hypercholesterolemia is associated with increased kidney graft loss caused by chronic rejection in male patients with previous acute rejection. Transplantation. 2000;70:464-472. Abstract.
Ciancio G, Burke GW, Gaynor JJ, et al. A randomized long-term trial of tacrolimus/sirolimus versus tacrolimus/mycophenolate mofetil versus cyclosporine (NEORAL)/sirolimus in renal transplantation. II. Survival, function, and protocol compliance at 1 year. Transplantation. 2004;77:252-258. Abstract.
McCune TR, Thacker LR II, Peters TG, et al. Effects of tacrolimus on hyperlipidemia after successful renal transplantation: a Southeastern Organ Procurement Foundation multicenter clinical study. Transplantation. 1998;65:87-92. Abstract.
National Heart Lung and Blood Institute. ATP III Full Report. 2002.
Massy ZA, Kasiske BL. Post-transplant hyperlipidemia: mechanisms and management. J Am Soc Nephrol. 1996;7:971-977. Abstract.
Kidney Disease Outcomes Quality Initiative. Am J Kidney Dis. 2003;41(suppl 3, No. 4):S1-S56.
FOR MORE INFORMATION & ORGANIZATIONS
Support Groups and Counseling
American Association of Kidney Patients
100 South Ashley Drive, Suite 280
Tampa, FL 33602
Phone: 813 223-7099
Toll Free: 800 749-2257
American Association of Kidney Patients
3505 E. Frontage Rd., Suite 315
Tampa, FL 33607
Toll Free: 800 749-2257
American Kidney Fund
6110 Executive Blvd, Suite 1010
Rockville, MD 20852
Phone: 301 881-3052
Toll Free: 800 638-8299
American Kidney Fund: www.akfinc.org
National Kidney Foundation
30 East 33rd St.
New York, NY 10016
Phone: 212 889-2210
Toll Free: 800 622-9010
American Urological Association
1000 Corporate Boulevard
Linthicum, MD 21090
Toll free (US only): 866-RING AUA (866-746-4282)
Phone: 410 689-3700
Fax: 410 689-3800
MORE WEB LINKS
National Institute of Diabetes and Digestive and Kidney Diseases
National Kidney and Urologic Diseases Information Clearinghouse
HOLISTIC & NUTRITIONAL RECOMMENDATIONS
Consume a diet composed of 75 percent raw food. Eat asparagus, bananas, celery, cucumbers, garlic, papaya, parsley, potatoes, and watercress. Watermelon and pumpkin seeds are also beneficial. Watermelon should be eaten by itself so that it passes through the system quickly. If it stays in the body too long, toxins begin to form. Also eat sprouts and most green vegetables.
Include in the diet legumes, seeds, and soybeans. These foods contain the amino acid arginine, which is beneficial for the kidneys.
Reduce your intake of potassium and phosphates if your levels are elevated. Do not use any salt or potassium chloride, a salt substitute. Also avoid beet greens, chocolate, cocoa, eggs, fish, meat, rhubarb, spinach, Swiss chard, and tea.
Drink 8 to 10 glasses of steam-distilled or quality water every waking hour. Quality water is essential for urinary tract function.
Reduce your intake of animal protein, or eliminate it altogether. A diet high in animal protein puts stress on the kidneys. Excess accumulation of protein can result in uremia. Protein is easiest to utilize if it has been broken down into free-form amino acids. Other good protein sources include beans, lentils, millet, peas, soybeans, and whole grains.
Avoid all dairy products except for those that are soured, such as low-fat yogurt, buttermilk and cottage cheese.
Try a raw goat's milk diet for 2 weeks, consuming nothing but 4 quarts of raw goat's milk, warmed to body temperature, each day. Add 1 tablespoon of crude blackstrap molasses to each quart. During this period, take 1,000 IU of Vitamin E and 75,000 IU Vitamin A in emulsion form. Note: If you are pregnant, do not take more than 10,000 IU of Vitamin A daily. (See Nutrient Supplements below)
Try a 3-day cleansing and juicing fast, and coffee or catnip tea enemas.
MoonDragon's Health Therapy: Fasting
MoonDragon's Nutritional Therapy: Juicing
MoonDragon's Health Therapy: Colon Cleanse
MoonDragon's Health Therapy: Enemas
MoonDragon's Health Therapy: Coffee Enema
MoonDragon's Health Therapy: Catnip Enema
If you are taking antibiotics for a kidney problem, do not take iron supplements as long as the problem exists.
If you have symptoms of kidney problems, especially blood in the urine or severe back pain, consult with your health care provider promptly. You may need medical treatment.
Buchu tea is good. Do not boil it, however.
Celery Seed and Parsley seed are natural diuretics. Taken in combination, they are especially helpful if high uric acid levels are present in the blood. Eating large amounts of animal proteins makes one susceptible to high levels of uric acid. These two herbs help keep them in check.
Cranberries contain substances tat acidify the urine, destroy bacterial buildup, and promote healing of the bladder. Drink at least 8 ounces of cranberry juice 3 times daily. Use only pure, unsweetened juice (available at health food stores, such as Trader Joe's). Do not substitute a commercial cranberry juice cocktail product since these contain large amounts of sugar. If natural cranberry juice is not available, cranberry capsules or powder may be used as a substitute.
Herbal Remedies: Cranberry Juice Concentrate, Natural Premium Quality, Kosher, Dynamic Health, 16 fl. oz.
Herbal Remedies: Cranberry Extract, Standardized, Vegetarian Supplement, 400 mg, 120 VCaps
Dandelion Root extract aids in excretion of the kidney's waste products and is very beneficial for nephritis.
Mountain Rose Herbs: Dandelion Extract, Certified Organic, 1 oz & 4 oz Sizes
Herbal Remedies: Dandelion Tea, NOW Foods, Organic, 30 Tea Bags
Herbal Remedies: Dandelion Root, Vegetarian Supplement, Nature's Way, 540 mg, 180 VCaps
Herbal Remedies: Dandelion Root Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Dandelion Root (Taraxacum Officinale) Powder, 4 oz. Bulk
The herbs Hydrangea and Uva Ursi are excellent natural diuretics. One of the best first steps in cleaning out the urinary tract and keeping it healthy is to help flush itself. Voiding the urinary tract keeps harmful deposits of calcium and other mineral salts from forming obstructions. Uva Ursi is also slightly germicidal, so if there are any bacteria present, they will likely be destroyed by it.
Mountain Rose Herbs: Hydrangea Extract, Certified Organic, 1 oz & 4 oz Sizes
Mountain Rose Herbs: Uva Ursi Extract, Certified Organic, 1 oz & 4 oz Sizes
Mountain Rose Herbs: Uva Ursi-Horsetail Combination Extract, Certified Organic, 1 oz & 4 oz Sizes
Herbal Remedies: Uva Ursi Leaves (Bearberry), 455 mg, 100 Caps
Herbal Remedies: Uva Ursi Extract, Standardized, 60 Caps
Herbal Remedies: Uva Ursi (Bearberry) Tincture, 2 fl. oz.
Herbal Remedies: Kidney Bladder Supplement Formula With Uva Ursi, Nature's Way, 485 mg, 100 Caps
Herbal Remedies: Hydrangea Tincture, 2 fl. oz.
Herbal Remedies: Hydrangea Root, Nature's Way, 415 mg, 100 Caps
Marshmallow tea helps to cleanse the kidneys. Drink 1 quart daily.
Herbal Remedies: Marshmallow Root (Althaea Officinalis) Powder, 4 oz. Bulk
Herbal Remedies: Marshmallow Root Tincture, 2 fl. oz.
Herbal Remedies: Marshmallow Root, Nature's Way, 455 mg, 100 Caps
Cornsilk is a natural diuretic for reducing water retention. Sp-6 Cornsilk Blend from Solaray helps reduce water retention. Kidney-Bladder Formula from Nature's Way is also another good herbal diuretic.
Herbal Remedies: Kidney Bladder Formula Supplement, Nature's Way, 465 mg, 100 Caps
Other herbs that are beneficial for kidney problems include:
Herbal Remedies: Goldenrod Tincture, 2 fl. oz.
Herbal Remedies: Juniper Berries, Nature's Way, 425 mg, 100 Caps
Herbal Remedies: Diuretic Extract Tincture, Herbal Remedies USA, 2 fl. oz.
Herbal Remedies: Nettle Leaf Tincture, 2 fl. oz.
Herbal Remedies: Nettle Leaf Tea, NOW Foods, Organic, 30 Tea Bags
Herbal Remedies: Parsley Root (Petroselinum Sativum) Powder, 4 oz. Bulk
Herbal Remedies: Parsley Detox Drops, 1 fl. oz.
Herbal Remedies: Parsley Leaf Herb, Nature's Way 450 mg, 100 Caps
Herbal Remedies: Red Clover (Trifolium Pratense) Herb Powder, 4 oz. Bulk
Herbal Remedies: Red Clover Herb, Nature's Way 500 mg, 100 Caps
Herbal Remedies: Red Clover Tincture, 100% Organic, 2 fl. oz.
Unless otherwise specified, the following recommended doses are for adults over the age of 18. For a child between 12 and 17 years, reduce the dose to 3/4 the recommended dose. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended dose.
NUTRIENTS Supplement Suggested Dosage Comments Very Important Acidophilus
As directed on label. Take on an empty stomach.
Kyo-Dophilus: Take 3 times daily. Take on an empty stomach.
Especially important if you are taking antibiotics.
Acidophilus Supplement Powder, Non-Dairy, 3 oz. Bulk,
Acidophilus, 3 Billion, NOW Foods, 90 Tabs,
Lactobacillus Acidophilus Supplement, Non-Dairy, 100 Caps,
Lactobacillus Acidophilus, Kosher Liquid, All Natural, Vegetarian Medium, Lactose Free, Apple Strawberry Flavor, Dynamic Health, 16 fl. oz.,
Coenzyme Q-10 As directed on label. Promote heart-muscle function.
CoQ10, Vegetarian Coenzyme, NOW Foods, 30 mg, 60 VCaps,
CoQ10, Now Foods, 400 mg, 60 Softgels
Coenzyme A As directed on label. Facilitates the repair of RNA and DNA. Supports the immune system's detoxification of many dangerous substances. Can streamline metabolism, ease depression and fatigue, and increase energy. Works with CoQ10. Acts as an antioxidant and removes harmful substances from the body.
Pantethine (Coenzyme A Precursor), Highly Active Form of Vitamin B-5, 300 mg, NOW Foods, 60 Softgels,
Vitamin B-6 (Pyridoxine) 50 mg 3 times daily. To reduce fluid retention.
Vitamin B-6 (Pyridoxine), Nature's Way, 100 mg, 100 Caps
(Inositol Hexaphosphate [IP-6])
50 mg daily.
100 mg daily.
To reduce fluid retention. Improves brain function and circulation to the brain. Use under professional supervision.
Choline Supplement, 100% Natural, Nature's Way, 500 mg, 100 Tabs,
Choline & Inositol, 100% Natural, Nature's Way, 250/250 mg, 100 Tabs,
Inositol (Vitamin B-8), 100% Natural, Pure Crystalline, Nature's Way, 500 mg, 100 Caps,
Vitamin C With Bioflavonoids 2,000-4,000 mg daily, in divided doses. Essential for adrenal function and production of adrenal hormones, which are vital for proper fluid balance and control of edema. Acidifies the urine, boosts the immune function, and aids in healing.
Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz.,
Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs,
Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps,
The Right C, Nature's Way, 1000 mg, 120 Tabs
Helpful Alfalfa 2,000-3,000 mg daily, in divided doses. Good source of minerals. Contains chlorophyll, a potent detoxifier.
Alfalfa Leaf Root (Medicago Sativa) Powder, Kosher, 4 oz. Bulk,
Alfa Max, Alfalfa Extract, Nature's Way, 525 mg, 100 Caps,
Alfalfa Powder, Whole Food Supplement, NOW Foods, 1 lb.,
Alfalfa Leaves, Nature's Way, 405 mg, 100 Caps,
Alfalfa, NOW Foods, 650 mg, 500 Tabs,
Alfalfa Tincture, 100% Organic, 2 fl. oz.,
Chlorofresh Liquid Chlorophyll, Mint Flavor, Nature's way, 16 fl. oz.,
Free-Form Amino Acid Complex As directed on label. Sometimes edema is caused by inadequate protein assimilation. Protein deficiency has been linked to water retention.
Amino 1000 Complete, NOW Foods, 120 Caps,
Branched Chain Amino Acid Powder, NOW Foods, 12 oz.,
Amino 1500, Chewable Blend of 20 Amino Acids, Predigested, NOW Foods, 150 Tabs,
Branched Chain Amino Acids, Free Form, 120 Caps
Bromelain As directed on label, 3 times daily. An enzyme derived from fresh pineapples that help digestion and allergies.
Bromelain 2000 GDU Supplement, NOW Foods, 500 mg, 90 Tabs
Calcium 1,500 mg daily. For proper mineral balance; calcium and magnesium should be in a 2:1 ration in the body. To replace mineral loss with correction of edema. Do not use bone meal, oyster shells, or dolomite as a source.
Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz.,
Liquid Calcium W/ConcenTrace, Orange Vanilla, Trace Minerals, 1000 mg, 32 fl. oz.,
Cal-Mag Pre-Chelated Calcium & Magnesium, Vital Earth, 240 Gelcaps
Magnesium 750 mg daily. Important in water absorption. To replace mineral loss with correction of edema. Helps uptake of calcium.
Magnesium Ionic Mineral Supplement, Fully Absorbable, 350 +/- ppm, 16 fl. oz.,
Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.,
Calcium & Magnesium Mineral Complex, 100% Natural, Nature's Way, 500 mg / 250 mg, 250 Caps
Garlic (Kyolic) 2 tablets 3 times daily, with meals. A detoxifier.
Garlic Oil Tincture, Alcohol Free, Nature's Way, 1 fl. oz.,
Garlic Bulb Cloves, Garlic Supplement, Nature's Way, 580 mg, 100 Caps,
Odorless Garlic Supplement, NOW Foods, 50 mg, 250 SoftGels,
Garlic Supplement, Kwai, Triple Concentrated, 180 Tabs,
Every Day Garlic Supplement, Kwai, 30 Tabs,
Garlic Tincture, 100% Organic, 2 fl. oz.,
Aged Garlic Extract, Cardiovascular Formula 100, Wakunaga Kyolic Supplements, 300 Caps,
Kyolic Liquid Aged Garlic Extract, Cardiovascular, Vegetarian, Wakunaga Kyolic, 4 fl. oz.,
Kyolic Aged Garlic Extract, One-A-Day, Vegetarian, 1000 mg, Wakunaga Kyolic, 30 Caps,
Aged Garlic Extract, Cholesterol Formula 104, Wakunaga Kyolic, 200 Caps
Kelp 1,000-1,500 mg daily. Supplies needed minerals.
Kelp Supplement, Nature's Way, Certified, 650 mg, 100 Caps,
Kelp Seaweed, Norwegian, NOW Foods, 100% Natural, 550 mg, 250 Caps,
Kelp Seaweed, Norwegian Powder, 4 oz. Bulk
Kidney-Bladder Formula 6-12 drops, 3 times daily. Contains soothing and diuretic herbs to help fight infection of the kidneys and bladder.
Kidney / Bladder Formula Tincture, 100% Organic, 2 fl. oz.
L-Arginine 500 mg 4 times daily. For kidney disease.
L-Arginine, Pharmaceutical Grade, Free Form, NOW Foods, 500 mg, 100 Caps,
L-Arginine, Pharmaceutical Grade, Vegetarian, NOW Foods, 1000 mg, 120 Caps
As directed on label, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg Vitamin B-6 and 100 mg Vitamin C for better absorption. For improved kidney circulation. See Amino Acids for more information.
L-Methionine, 500 mg, Plus Vitamin B-6, 10 mg, NOW Foods, 100 Caps
Hydrochloric Acid (HCl)
As directed on label. Necessary for digestion. Caution: Do not give this supplement to a child under 16 years of age except as directed by a health care provider.
Super Digestive Enzymes With Betaine HCl, 60 Caps,
MetabolicZyme (Hypoallergenic), Allergy Research Group / Nutricology, 900 Tabs,
Plant Enzymes, NOW Foods, Vegetarian, 120 VCaps,
Enzymes, All Complete, 250 mg, 90 Caps,
Procaine Ultra GH9 (Ultimate 9), Procaine HCl, 100 mg, 60 Caps,
Multi-Mineral Complex As directed on label. Supplies important minerals and corrects mineral depletion, common with kidney disease. Use a high potency formula.
Super Mineral Juice (Liquid Mineral), Blueberry Flavor, Trace Minerals, 32 fl. oz.,
Super Mineral Juice (Liquid Mineral), Peach Flavor, Trace Minerals, 32 fl. oz.,
Encapsulated Multi-Mineral & Mineral Formulas
Potassium 99 mg daily. Very important if taking diuretics. Acts as a kidney stimulant. Needed for nephritis. Note: Omit this supplement if serum potassium is elevated.
Potassium Ionic Mineral Supplement, Fully Absorbable, 340 +/- ppm, 16 fl. oz.,
Potassium Chelate, 100% Natural, Nature's Way, 99 mg, 100 Caps,
Potassium Chloride Powder, NOW Foods, Vegetarian, 8 oz.
Silica As directed on label. A natural diuretic.
Cellfood Silica Liquid Drops, CellFood, 4 fl. oz.,
Silica Gel, Original Supplement, Nature's Way, Vegetarian, 90 VCaps,
Silica Complex, 8% Extract, Silica Supplement, NOW Foods, 500 mg, 90 Tabs
SP-6 Cornsilk Blend
2 capsules 3 times daily. Contains cornsilk and other herbs that aid the body in expelling excess fluids. Vitamin A 100,000 IU daily for 3 days, then 50,000 IU daily for 5 days, then reduce to 25,000 IU daily. If you are pregnant, do not exceed 10,000 IU daily. Important in healing of urinary tract lining, tissue repair and proper immune function. Use emulsion form for easier assimilation and greater safety at higher doses. Capsule forms put more stress on the liver.
Vitamin A, 10,000 IU, 100% Natural, Nature's Way, 100 Softgels,
As directed on label. Powerful antioxidants, free radical scavengers, and immune enhancers (strengthens the immune response). May protect against cancer and heart disease.
Beta Carotene (Natural Dunaliella Salina), Nature's Way, 100% Natural, 25,000 IU, 100 Softgels,
Multi-Carotene Antioxidant, Nature's Way, 60 Softgels
Vitamin B Complex 50-100 mg twice daily, with meals. All B vitamins work best when taken together.
Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs,
Vitamin B-100 Complex, w/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps
Vitamin B-2 (Riboflavin)
25 mg 3 times daily. Needed for nephritis.
Vitamin B-2 (Riboflavin), 100% Natural, Nature's Way, 100 mg, 100 Caps
Vitamin E 200-400 IU daily (200 IU daily or 400 IU every other day suggested). Promotes immune function. An important free radical destroyer. Use d-alpha-tocopherol form.
Ester E Natural Vitamin E, California Natural, 400 IU, 60 Softgels,
Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels,
Vitamin E-1000, NOW Foods, 1000 IU, 100 Gels,
Vitamin E, d-alpha-tocopherol, 400 IU, 100 Softgels
Zinc 50-80 mg daily. Do not exceed a total of 100 mg daily from all supplements. An immunostimulant necessary for healing and an important inhibitor of crystallization and crystal growth. Helps to control inflammation. Use zinc gluconate lozenges or zinc methionate (OptiZinc) for best absorption.
Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.,
Colloidal Silver & Zinc Lozenges, Silva Solution, 90 Lozenges,
Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges,
Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 Caps
3 mg daily. Needed to balance with Zinc.
Copper Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.,
KIDNEY DISEASE SUPPLEMENTAL PRODUCTS
Supplements and products for kidney disease, a disease that occurs when the kidneys permanently lose the ability to remove waste and maintain the fluid and chemical imbalances in the body.
AHCC (Active Hexose Correlated Compound), NOW Foods, Vegetarian, 500 mg, 60 VCaps
NOW Foods AHCC is a rich source of polysaccharides such as beta glucan 1,3 and activated hemicellulose produced by enzymatic modification of organic medicinal mushrooms, including shiitake.
Alfalfa Leaf Root (Medicago Sativa) Powder, Kosher, 4 oz. Bulk
Alfalfa's (Medicago sativa) deep root system pulls valuable minerals from the soil. With the aid of sunlight, nutrients including beta carotene and chlorophyll are made available to the body in a usable form.
Alive! Whole Food Energizer, Multi-Vitamin & Mineral With Naturally Occurring Iron (No Iron Added), Nature's Way, 90 Tabs
No other supplement contains more life-giving nutrients than Nature's Way Alive Multi-Vitamin. Alive Multi-Vitamin is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands.
Astragalus Immunity Herbal Tea, 20 Tea Bags
Help maintain normal functions of the liver, lung, kidney, stomach and heart, to boost energy, defer aging, detoxify, etc. To bolster white blood cells growth, support the immune systems, and to promote the effect of other herbs, and help reduce side effect of chemotherapy and radiation.
Back To Youth, TCM Formula, Congrong Huanshao, 100% Natural, 60 Caps
Back to Youth, TCM Formula is made of extracts from prepared rehmannia root, common yam, achyranthes, wolfberry, dogwood fruit, poria, salty eucommia bark, polygala prepared with licorice, roasted morinda, schizandra fruit, salty fennel, chinquapin seed, cistanche, acorus root and common jujube fruit, Chinese herbs for aging.
Bayberry Root Bark, Nature's Way, 475 mg, 100 Caps
Bayberry root bark is often used for its astringent properties and can boost the immune system.
Branched Chain Amino Acids, Free Form, 120 Caps
Studies on people with alcoholic cirrhosis have shown a benefit to consuming L-valine, L-leucine, and L-isoleucine. These branched-chain amino acids enhance protein synthesis in liver cells, help restore liver function, and prevent chronic encephalopathy.
BriteMind Elder For Enhanced Brain Function, Luma Congmin, 100% Natural, 500 mg, 60 Caps
This time honored formula is used in Chinese medicine to maintain healthy brain and mental functions, and sexual potency.
Bromelain 2000 GDU, NOW Foods, 500 mg, 90 Tabs
Bromelain is a proteolytic digestive enzyme that can enhance absorption of protein. Bromelain may also affect protein turnover in the body including proteins found in joint tissue.
Buchu Leaves Tincture, Alternative Health & Herbs Remedies, 2 fl. oz.
Buchu leaves act as a diuretic and antiseptic, and today is used in treating inflammation of the urethra, blood in the urine, bladder infections, and other chronic urinary tract disorders.
Buckthorn Bark Tincture, 100% Organic, 2 fl. oz.
Buckthorn has been one of the few herbs to be used consistently throughout history for the same ailment: constipation and its by-products, hemorrhoids and anal irritation.
Cayenne Pepper Oil, 2 fl. oz.
Cayenne Pepper is beneficial for the heart, kidneys, lungs, pancreas, spleen, and stomach. When combined with other herbs, Cayenne Pepper helps increase their effectiveness by helping them enter the blood stream faster.
Celery Seed Tincture, 100% Organic, 2 fl. oz.
Celery seed, an arthritis herbal remedy, also has an ancient reputation for treating muscle spasms, high blood pressure, gout, sleeplessness, depression, and anxiety.
Choline Supplement, 100% Natural, Nature's Way, 500 mg, 100 Tabs
Nature's Way Choline Supplement is 100% natural choline with improved absorption.
Colon & Liver Cleanser, 16 fl. oz.
CAC liquid is a colon and liver cleanser and detoxifier as well as a blood cleanser that serves to regulate the bowel movements so that the stool is so soft it breaks up into a cloud.
Coral Calcium (Okinawa) Plus Magnesium & Vitamin D, 100% Natural, NOW Foods, 500 mg, 100 VCaps
Okinawa Coral Calcium Plus with Magnesium, Vitamin D and 70 other trace minerals provides essential minerals, restores body alkalinity, supports the immune system, and is bio available for better absorption.
Corn Silk Tincture, 100% Organic, 2 fl. oz.
Cornsilk is used to soothe the urinary tract and can give relief to the bladder, kidneys and small intestines.
Dandelion Root (Taraxacum Officinale) Powder, 4 oz.
Dandelion root is known as a blood purifier for liver and kidney disorders. Dandelion root also contains nutritive salts to build up the blood.
Dandelion Root Tincture, 100% Organic, 2 fl. oz.
Dandelion root is a natural diuretic and improves appetite and minor digestive problems. Dandelion leaves are commonly recommended as a food supplement for pregnant and post-menopausal women.
Dr. Clark Kidney Cleanse, 8 Part Unique System, 4 Week Cleanse Kit
The Dr Clark Kidney Cleanse includes herbs traditionally used to support the cleansing of the kidneys of waste materials, including those from the activity of kidney stones, edema in lungs, arms, or abdomen.
Femaprin Vitex Chaste Tree Berry Extract, Pharmaceutical Grade, Nature's Way, 425 mg, 60 Caps
Femaprin's Chaste Tree Berry is unique formula combines clinically proven standardized Vitex Chaste Tree Berry extract with Vitamin B-6 to help alleviate the bloating, breast tenderness and mood changes associated with premenstrual syndrome.
Fluid Retention Wellness Oil, Nature's Inventory, 2 fl. oz.
The oils in this formula are designed to accelerate the body's fluid drainage system.
Ginkgo Biloba Extract, Standardized, Nature's Way, 60 mg, 120 Vegetarian Caps
Nature's Way Ginkgo biloba extract is a technically and scientifically advanced herbal extract standardized to 24% Ginkgo flavone glycosides and 6% terpene lactones, supported by whole Gotu Kola herb.
Gravel Root Tincture, 100% Organic, 2 fl. oz.
Today Gravel root is used for kidney stones, cystitis, and pelvic inflammatory disease. Because it encourages the excretion of excess uric acid, it is also used to treat rheumatism and gout.
Hair Rejuvenation Herb Tea, 100% Natural, Caffeine Free, 20 Tea Bags
Chinese medicine uses their blood circulation promoting, internal secretion regulating, liver and kidney nurturing, bacteria and fungus inhibiting properties to maintain hair growth and to fend off premature grey hair.
Hawthorne Leaf Tincture, 2 fl. oz.
Hawthorne is one of the most valuable herbs for the heart and circulation.
Hydrangea Tincture, 2 fl. oz.
Hydrangea is used in the treatment of kidney and bladder stones. It is thought both to encourage the expulsion of stones and to help dissolve those that remain.
Juniper Berries, Nature's Way, 425 mg, 100 Caps
Juniper berries strengthen the urinary system and help the body eliminate excess water and toxins. Juniper berries (Juniperis communis) were used as a food and a medicine by the Indians of the American plains.
Kelp Seaweed (Norwegian) Tincture, 100% Organic, 2 fl. oz.
Due to overwhelming research results, Kelp has become an effective treatment for hyperthyroidism.
Kelp Seaweed Norwegian, NOW Foods 100% Natural Acophyllum Nodosum, 550 mg, 250 Caps
Norwegian Kelp seaweed contains nearly thirty minerals which nourish the glands, especially the thyroid and pituitary. Kelp, also known as seaweed, grows in the rich ocean beds, far below surface pollution levels.
Kidney / Bladder Formula Tincture, 100% Organic, 2 fl. oz.
Use the Kidney Bladder Formula for Auto-immune Diseases, Bladder, Cancer, Cold Sores and deposits.
Kidney Bladder Formula w/ Uva Ursi, Nature's Way, 465 mg, 100 Caps
Nature's Way Kidney Bladder Formula contains Uva Ursi (Bearberry) and Juniper berry, two historically popular for kidney and bladder complaints.
Kidney Clean, Balanceuticals, 60 Caps
Traditional Chinese medicine uses their special cleansing properties to promote blood circulation, dissolve stasis and accelerate rejection of waste and toxins from kidney and urinary tract.
Kidney Fortifier Herbal Tea, 20 Tea Bags
This soothing kidney tea is made of naturally harvested herbs. Chinese medicine uses these herbs as them as a diuretic and to maintain healthy kidney functions.
Kidney Rejuvenator, Peter Gillhams Natural Vitality, 90 Tabs
Kidney Rejuvenator is a proprietary blend of powerful herbs that support the kidney's vital functions.
Kidney Support Wellness Oil, 2 fl. oz.
Kidney Support Wellness Oil was designed to promote the health of your kidneys.
Kombucha Miracle Fungus, Kombucha Tea Benefit's, By Harald Tietze, Paperback
One time best seller, Kombucha Miracle Fungus is all about synergy and Kombucha Tea Benefit's it is an easy read for those interested in the synergy Kombucha offers or Kombucha benefit's.
Marshmallow Root, Nature's Way, 455 mg, 100 Caps
Nature's Way Marshmallow root is Certified Organically Processed by Oregon Tilth. It exceeds California Health and Safety Code 26569.11. Marshmallow Root has soothing properties and nutritionally supports the respiratory and gastrointestinal systems.
Marshmallow Root Tincture, 2 fl. oz.
The primary use of Marshmallow root is to relieve digestive and respiratory problems, such as coughs, colds, sore throats and asthma.
NephroEase For Kidney Health, TCM Formula, Luma Yushen, 100% Natural, 500 mg, 60 Caps
Used in Chinese medicine for its nutritive, brain nurturing, cardiotonic, diuretic, kidney tonifying, liver supporting, bone and muscle strengthening, spleen and kidney warming.
Parsley Root Tincture, 100% Organic, 2 fl. oz.
Considered a strong diuretic, useful against fluid retention, urinary/kidney stones and urinary infections. Strengthening to the digestion.
Patchouli Oil, 100% Organic Essential Oil, 2 fl. oz.
Using Patchouli in inhalation, baths, and massage has an uplifting effect on depression and anxiety, and can help alleviate fluid retention.
Pelargonium, Coughs & Chest Ailments, 3 fl. oz.
Pelargonium is rich in phytochemicals, vitamins, minerals, and amino acids that enhance the body's functioning and protects it against diseases.
PMS Formula w/ 5HTP & Vitamin B-6, Nature's Way, 100 Caps
This formula represents the powerful synergy of current scientific research and traditional herbal medicine.
Pomegranate Extract, Standardized To 40% Ellagic Acid, Nature's Way, 60 VCaps
Pomegranate Extract is standardized to 40% ellagic acid from a pure whole-fruit source to maximize its antioxidant benefits.
Pomegranate Juice Concentrate, Natural Kosher, Dynamic Health, 8 fl. oz.
This Pomegranate Juice Concentrate comes in a convenient 8 ounce size and has no preservatives and no sugar added. Pomegranate juice is highly nutritious and contains energy-giving proteins as well as lime, iron and phosphorus.
Potassium Chloride Powder, NOW Foods, Vegetarian, 8 oz.
This potassium chloride powder can be used as a substitute for table salt or in baking, although the taste is not identical.
Potassium Ionic Mineral Supplement, Fully Absorbable, 340 +/- ppm, 16 fl. oz.
WaterOz Ionic Potassium is a pure liquid Potassium supplement. Potassium aids rheumatic or arthritic conditions and is vital for the elimination of wastes.
Resveratrol Synergistic Formula, Nature's Way, 37.5 mg, 60 Caps
Japanese knotweed is a potent source of Resveratrol and has been used for the heart, liver and blood vessels.
Simple Diagnostic Tests You Can Do Yourself At Home, By Martha M. Christy
This is an excellent resource that explains in easy-to-follow language simple at-home tests you can perform to learn of your body's nutritional deficiencies or potential for certain illnesses.
Solid Bone For Bone & Muscle Strength, TCM Formula, Luma Zhuanggu, 500 mg, 60 Caps
This time-honored formula is used in Chinese medicine for its bone and muscle strengthening to maintain healthy, strong bones and muscles.
Turmeric Extract (Curcuma Longa), Standardized To 95% Curcuminoids, Nature's Way, 500 mg, 120 Tabs
Nature's Way standardized Turmeric extract is a technically advanced herbal extract standardized to 95% curcuminoids. This is the highest concentration of curcuminoids available.
Urinary Supplement Formula, With Cranberry Fruit, Nature's Way, 480 mg, 100 Caps
Nature's Way Urinary Supplement formula is an advanced dietary supplement representing the powerful synergy of current science and traditional herbal medicine.
Vitamin C 1000 with Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 Vcaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.
Vitamin C 500 With Bioflavonoids, 100% Natural, 500 mg, 250 Capsules
Vitamin C 500 With Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.
Vitamin E, D-alpha Tocopherol, 400 IU, 100 Softgels
Vitamin E has potent antioxidant activity, supplies oxygen to the blood, aids in strengthening capillary walls, and plays a beneficial role in cancer and cardiovascular disease prevention, anti-aging benefits, circulation, wound-healing, immune function, nervous system function, PMS, hot flushes, diabetes, vascular disease, eye health, tissue repair, athletic performance, leg cramps, skin and hair health, and alleviating fatigue.
Wolfberry Tincture, Goji Juice Concentrate (Lycium Barbarum), 2 fl. oz.
Wolfberry (Goji) has healing benefits of nourishing and strengthening the eyes, liver, kidneys and nourishing the blood.
Yohimbe (Corynanthe Yohimbe) Powder, 4 oz. Bulk
Orally, yohimbe is used as an aphrodisiac, for impotence, exhaustion and even angina. Yohimbe is also used for general sexual dysfunction in men and women.
Yohimbe Tincture, 100% Organic, 2 fl. oz.
Yohimbe is often used for impotence and sexual dysfunction. Yohimbe can also be used for High blood pressure, Arteriosclerosis, Angina pectoris, and as a local anesthetic.
HerbalRemedies: Kidney Disease Information
HerbalRemedies: Kidney Disease Supplements & Products
HerbalRemedies: Edema / Water Retention Information
HerbalRemedies: Edema / Water Retention Supplements & Products
HerbalRemedies: Nephritis Supplements, Information & Products
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
Notify your midwife you develop signs of toxemia of pregnancy (preeclampsia/eclampsia). See Toxemia for more information.
Several signs and symptoms may suggest complications of chronic kidney disease. Call your health care provider if you notice any of the following symptoms:
- Change in energy level or strength.
- Increased water retention (puffiness or swelling) in the legs, around the eyes or in other parts of the body.
- Shortness of breath or change from normal breathing.
- Nausea or vomiting.
- Light-headedness or dizziness.
- Severe bone or joint pain.
- Easy bruisability.
If you have diabetes, high blood pressure, or kidney problems, see your health care provider right away if you know or suspect that you are pregnant. See your health care provider as recommended for monitoring and treatment of chronic conditions such as diabetes, high blood pressure, and high cholesterol.
Some signs and symptoms represent the possibility of a severe complication of chronic kidney disease and warrant a visit to the nearest hospital emergency department.
- Change in level of consciousness - extreme sleepiness or difficult to awaken.
- Chest pain.
- Difficulty breathing.
- Severe nausea and vomiting.
- Severe bleeding (from any source).
- Severe weakness.
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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