Chronic kidney disease

Kidneys, the conscientious workers

Our kidneys are one of those organs in our body which we usually take for granted – they are like those really dedicated and reliable employees who always show up, do their work diligently in the background, very seldom complain about the workload and simply get on with it. We’re far more aware of our other organs and what they do; think of your heart pounding, and lungs filling to the brim with fresh air on a really hectic run, ensuring you get enough oxygen to every cell of the body, or what about your stomach rumbling when you haven’t eaten all day, or that bladder about to burst when there is no toilet in sight. Our kidneys are far less in the limelight and in most cases, we never really know they’re there unless something is seriously wrong. Despite this low-profile existence, healthy kidney function is critical to life.

Most of us know that one of the major functions of the kidneys is to filter our blood, but in reality they filter the liquid part of our blood called plasma. Most don’t realise that this is done through microscopic filters called nephrons. Believe it or not, but each kidney contains about one million of these filtering tubes, and if you added them all together, they would stretch over 160km! Wait, it gets even more amazing – the nephrons of both kidneys filter around 115-125ml per minute (something medically called glomerular filtration rate [GFR]). That’s 7.5 litres an hour and around 180 litres per day. Considering we have around 5.5 litres of blood in total, effectively that means our total blood volume is filtered every 40 minutes, talk about quietly getting on with the job!

Through this filtration process, the kidneys cleverly release unwanted substances into the urine for excretion like the toxic waste products urea and creatinine and other unwanted chemicals, but at the same time recycle and claim back important ones such as glucose, minerals, vitamins and water according to the needs of the body. By doing this, they can control the volume of blood plasma, the concentration of waste products in the blood, as well as very importantly the level of electrolytes which affect and control hydration levels and blood pressure levels. By excreting excess acid in the form of hydrogen ions (H+) and reabsorbing alkaline bicarbonate, the kidneys are also vital for controlling blood pH which has to be kept within the narrow, slightly alkaline range of 7.35-7.45.

The kidneys also perform other less known functions. Did you know they also produce hormones? One of these is erythropoietin which very importantly stimulates bone marrow to make red blood cells which are crucial for carrying oxygen to all our cells. The other unexpected role they have is to convert vitamin D from our diet or from sun exposure into a form that our bodies can use. This has important implications for bone health and controlling calcium and phosphorus levels in the body.

So, what happens when kidney function is compromised?

Now that we have a basic idea of what the kidneys do, we can reasonably predict what will happen if they are weakened, right? Well, it’s not that simple, because the body is remarkably resilient and able to compensate for deficiencies in many forms, and because of this, people only start to develop overt symptoms of kidney weakness once they are severely weakened, and by then often irreversible damage is done!

Irrespective of the cause, when the kidneys are damaged and the amount they filter (remember that medical term glomerular filtration rate – GFR) drops below 60ml per minute for more than 3 months, chronic kidney disease (CKD) is diagnosed. Medically the word ‘chronic’ simply means ongoing and long lasting, so CKD simply means a long-term kidney weakness. As with most chronic medical conditions, there are different stages of disease depending on how far advanced the condition is. In CKD there are 5 stages:

Most patients in stages 1-3 are relatively ‘symptom free’ and may not even know they have early CKD; this is a major problem because valuable time is being lost in which active interventions can be made to address the problem or at very least stop or slow down further deterioration.

Signs and symptoms of advancing CKD include:

• Unusual tiredness and weakness (progressively getting worse over time).
• Vague, general unwell feeling ‘toxic feeling’ with headaches.
• Insomnia and sleep problems.
• Possible breathlessness.
• Decreased mental alertness.
• Urine may be unusually dark, smelly, or very concentrated.
• Unusual quantities of urine, too little or too much.
• Swelling and water retention of the ankles, face or elsewhere.
• Muscle cramps or twitches or weakness.
• Low back pain or discomfort over the kidney area.
• Loss of appetite or nausea and/or vomiting.
• Dry, itchy skin problems.
• Gout and kidney stones.

Other medical features that could co-exist with CKD:

• Diabetes, high blood pressure or obesity.
• Blood, sugar or protein in your urine.
• Anaemia.
• Vitamin D deficiency.
• High potassium levels in your blood.
• Gout.

Causes of CKD?

How does one end up with CKD? It’s important to realise that kidney function naturally starts to decline with age and GFR of a young adult vs an elderly patient will certainly differ so older patients are at risk. Statistically speaking however, the major causes of actual CKD in developing countries are uncontrolled diabetes mellitus (9-30% of cases) and uncontrolled high blood pressure (13-21%). Other causes include chronic kidney infections and blockages, certain medications, exposure to toxins, or other diseases of the kidney structure. Other factors that increase the risk of CKD are smoking, obesity, and family history thereof.

How common is CKD?

The international statistics on CKD are alarming. It doubled as a cause of death between 1990 and 2010, and as early as 2010 it was the18th highest cause of death worldwide. With this, internationally the number of people needing ongoing dialysis has doubled since 1990. Here in sub-Saharan Africa we are particularly affected, with researchers predicting that by 2030 more than 70% of all people with CKD will be from low income countries. In South Africa the prevalence, this is the number of people who currently have the disease, is around 14% i.e. that’s around 840 000 people!

What’s even more worrying is that in the USA alone, for every patient with end stage renal disease (ESRD) there are more than 200 with Stage 3-4 CKD and 5000 with Stage 1 and 2. Given that the number of diabetics are expected to double by 2030 and obesity and high blood pressure is growing at an alarming rate, the implications of this for new cases of CKD are staggering.

How is CKD treated?

Unlike the liver for example, the kidneys cannot regenerate themselves once they are damaged. There is no actual cure for CKD, rather the condition is managed. Firstly, the underlying causes are identified and addressed. These include controlling blood pressure, and blood sugar, treating chronic infections etc. This is followed by symptomatically managing the features of the condition such as assisting with control of minerals, pH balance, anaemia, swelling and so on. Although these interventions can help temporarily, even patients with access to the best care available often eventually progress to end stage renal failure (ESRD) or stage 5, at which point dialysis becomes a necessity and kidney transplant is considered if possible.

Prevention is better than cure!

Detect it early

In a condition such as this one cannot overemphasise how important it is to prevent this condition! This means having regular health screening tests for blood pressure, blood sugar, as well as a urine dipstick test which checks for sugar, protein, blood or infections in your urine. If you are over 50, have high BP or are diabetic, ask your doctor for a kidney function blood test called a urea & electrolytes (U&E). This must be done at least annually or more frequently if necessary. Very importantly ask your doctor, ‘what is my eGFR?’, often we don’t do this and they don’t tell us! It’s important for us to know, so we can be motivated to make dietary and lifestyle changes which may support our kidneys.

Make fundamental lifestyle changes, it could save your life!

CKD is serious and we should not just rely on medicines, we need a holistic approach this includes a healthy diet which should exclude processed foods, refined carbohydrates, sugar, and salt and drinking at least 1.5 litres of water per day. Water is grossly underrated and is a simple way to support healthy kidneys. Many people today consume more coffee, tea and cooldrinks than actual water, which is often one of the first places we go wrong in terms of kidney health. A more alkaline diet (less animal protein and meat and more fresh fruits and vegetables) is ideal and has been shown to be beneficial for CKD patients. High protein diets are an absolute no-no if you have weak kidneys, this is a proven fact! Seeing a dietician is a really good idea to get a tailored diet which can address CKD and possible related BP or diabetes. You may also be required to reduce your potassium intake and in some forms of CKD gout starts to occur, it is thus a good idea to get professional advice on how to control your potassium and reduce your intake of purine rich foods.

Exercise and weight loss will go a long way to supporting the system with CKD, especially if high blood pressure, obesity or diabetes are involved. The evidence showing the positive effects of these lifestyle interventions are impressive. Controlling and managing stress is easier said than done, but chronic stress worsens blood pressure, and makes controlling diabetes more challenging. An unsustainable lifestyle leading to protracted stress is an obstacle in managing any chronic condition and needs serious consideration if applicable.

Treat and/control the causes

If blood pressure or diabetes are the cause, make sure that these are properly controlled and thoroughly monitored to prevent further harm to the kidneys. Advanced CKD requires an assessment by a specialist nephrologist, but don’t just rely on medicines, make the lifestyle changes mentioned above too! Detect and treat bladder and kidney infections early, and if you get them repeatedly, see a specialist to find out why to resolve them permanently. If you are taking prescription medication for other problems, ask you pharmacist or doctor if any of them could worsen kidney function – there are many chronic medicines which could make CKD worse.

Natural remedies to support kidney health

Knowing what our kidneys do for us and how serious kidney damage can be, another proactive measure one can take to support healthy kidney function on a regular basis, especially if you know you are at risk, are herbal remedies. One such remedy is A.Vogel Nephrosolid, a kidney tonic consisting of 4 key herbs for the urinary system designed by famous Swiss Naturopath Dr Alfred Vogel who was a firm believer in preventative medicine.

A.Vogel Nephrosolid is made in Switzerland from fresh plant extracts of well-known kidney herbs including Solidago, Silver birch, Restharrow and Horsetail and is a tonic to support the function of the kidneys, bladder and urinary tract, which can be used in the following ways:

• As a tonic for routine maintenance of kidney and urinary tract health

And a supportive treatment for:

• the general signs and symptoms of urinary tract disorder.
• the signs and symptoms of kidney and urinary tract infections and inflammation.
• mild fluid retention.
• kidney stones and the prevention thereof.

To support general kidney, bladder and urinary tract health in adults and children over 12 years:

Take 15 drops three times daily in water or as prescribed by your doctor.

References

1. American Kidney Fund – Chronic Kidney Disease. Online: https://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/
2. American National Kidney Foundation – Kidney Basics. Online: https://www.kidney.org/kidney-basics
3. Barsoum, R., Chronic Kidney Disease in the Developing World. New England Journal of Medicine, 2006. 354(10): p. 997-999. https://pubmed.ncbi.nlm.nih.gov/16525136/
4. Goraya, N., et al., Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate. Kidney Int, 2014. 86(5): p. 1031-8. https://pubmed.ncbi.nlm.nih.gov/24694986/
5. Levey, A.S., et al., Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney International, 2005. 67(6): p. 2089-2100. https://pubmed.ncbi.nlm.nih.gov/15882252/
6. National Kidney Foundation of South Africa (Nkfsa). Facebook Page: https://www.facebook.com/Nkfsa-National-Kidney-Foundation-of-SA-305907116088545
7. Passey, C., Reducing the Dietary Acid Load: How a More Alkaline Diet Benefits Patients With Chronic Kidney Disease. J Ren Nutr, 2017. 27(3): p. 151-160. https://pubmed.ncbi.nlm.nih.gov/28117137/
8. Stanifer, J.W., et al., The epidemiology of chronic kidney disease in sub-Saharan Africa: a systematic review and meta-analysis. The Lancet Global Health, 2014. 2(3): p. e174-e https://pubmed.ncbi.nlm.nih.gov/25102850/
9. Turner, J.M., et al., Treatment of chronic kidney disease. Kidney International, 2012. 81(4): p. 351-362. https://pubmed.ncbi.nlm.nih.gov/22166846/