Treatment for Kidney Diseases
Treatment of kidney disease is a complex issue and depends on the type, underlying cause, and duration of the disease. Treatment usually starts with addressing the original cause (eg, inflammation). Inflammation from infection is treated with antibiotics. Inflammation caused by an immune reaction is more difficult to treat. In this case, immunosuppressant drugs (corticosteroids) are used in an attempt to control the immune reaction.
In the case of acute kidney failure, treating the underlying cause may return the kidneys to normal function. Sometimes dietary restrictions (less salt and protein) are required until the kidneys are better able to handle these substances. Diuretic medicines help the body to excrete more water and salt. However, with chronic kidney failure, medicines are used to stop the disease from progressing to ESRD.
When kidney disease does not respond to treatment with dietary restrictions and medications, dialysis or kidney transplantation are the next treatments to consider (Glanze 1996). Dialysis is a technique used to remove waste products from the blood and excess fluid from the body (in the case of renal failure). Kidney transplantation is a surgical procedure in which the diseased kidney (sometimes both kidneys) is removed and replaced with a healthy kidney from a donor (NIDDK 1999).
Conventional Medical Treatment
Medicine and Drugs
Four percent of the United States population is at risk for kidney disease. An annual physical checkup should include blood levels of creatinine, blood urea nitrogen (BUN), and urine levels of protein. Small elevations of creatinine can be an early sign of kidney disease. According to the National Kidney Foundation (2001a), 11 million Americans have elevated blood levels of creatinine. Healthy kidneys remove creatinine, but when kidney function diminishes, creatinine levels in the blood rise. Early detection leads to early treatment, which can help prevent kidney disease from advancing to a more serious stage. Diabetes is the leading cause of chronic kidney disease, followed by hypertension. See your physician regularly and follow prescribed dietary and drug treatment to control blood sugar levels and blood pressure (National Kidney Foundation 2001a). Treatment options for conditions that can lead to kidney disease include numerous prescription drugs and treatment protocols. See the following Life Extension protocols: Diabetes, Immune System Strengthening, Atherosclerosis and Cardiovascular Disease [sections on Homocysteine and Hypertension], Thyroid Regulation, and Urinary Tract Infection for additional information on specific conditions and treatment.
Protecting Kidneys Against Inflammatory Attack
Pentoxifylline (PTX) is a prescription drug approved by the FDA to treat peripheral vascular disease. The standard dose is 1200 mg daily to improve circulation. To suppress proinflammatory cytokines often involved in age-related renal impairment, a lower dose of 400 mg twice daily can be used. Note: Refer to pentoxifylline precautions in the summary section before using this drug.
A controlled study on human diabetics with advanced renal failure showed that 400 mg daily of PTX reduced tumor necrosis factor-alpha (TNF-α) levels by approximately 35%. In the PTX group, a measurement of kidney impairment was reduced 59%. There were no changes in those given placebo. Researchers noted that inflammatory cytokines such as TNF-α have long been implicated in the development and progression of diabetic kidney failure (Navarro 1999a). Organ failure induced by TNF-α has been confirmed by other studies (Boldt 2001).
In advanced kidney failure, anemia can be induced by an inflammatory cytokine attack on erythropoietin, the major natural hormone responsible for red blood cell (RBC) production. In a group of 7 anemic patients with advanced renal failure, PTX suppressed TNF-α and reversed the anemic state (Navarro 1999b).
Kidney dialysis is a medical treatment used to filter out waste products from the blood. Dialysis has been proven to be an effective technique for removing waste and extra fluid from the body. According to the annual report of the United States Renal Data System, 400 000 persons in the United States were using dialysis treatment in 2009 (USRDS 2012). Dialysis treatment permits these people to live relatively normal lives within the limitations of their disease.
The two types of dialysis methods are hemodialysis and peritoneal dialysis. The most common technique is hemodialysis, accounting for slightly over 85% of dialysis treatment. The remaining 15% of patients use peritoneal dialysis (NIDDK 2001b). Neither is uncomfortable and both are equally effective in removing wastes and extra fluids from the body. The choice is usually based on preference or level of convenience desired by the patient in consultation with appropriate medical professionals.
Even for dialysis patients, kidney failure can cause other health-related problems over time, including high blood pressure (including a latent nocturnal factor), bone disease, anemia, and nerve damage. As kidney function declines past the minimum threshold, kidney transplant becomes the only hope for patients with advanced ESRD.
Studies on human dialysis patients indicate that a high number of free radicals are formed in response to dialysis and antioxidant supplements can protect against this damage (Saionji 1999; Wratten 1999; Clermont 2000).
Statistical surveys of medical facilities, which occur yearly, indicate that kidney transplantation accounted for 13 483 transplant operations in 1999 (NIDDK 2001b). In the United States, many people live with a functioning kidney as a result of transplantation. However, it is very difficult to obtain accurate statistics on the number of people living with a functioning kidney transplant at any given time. Unfortunately, each year patients die while awaiting a matching donor kidney. According to the NIDDK (2001b), as of November 2, 2001, there were 50 305 people awaiting a kidney transplant. To be a potential candidate for kidney transplantation, a person must have kidney function estimated to be below 15% and must not be positive for certain diseases, such as unstable coronary artery disease, infection, or glomerulonephritis (ie, inflammation of the tiny blood vessels in the nephrons where blood is filtered in the kidneys). It is usually caused by an autoimmune disease, but can also be caused by infection.
Can Renal Replacement Therapy Be Deferred? A study was conducted to determine if a very low-protein diet could defer renal replacement therapy (RRT) in patients with chronic renal failure. High protein intake is known to be stressful for the kidneys and over time, can be a contributing factor to a slow, pervasive decline in kidney function. Two groups of patients were put on a very low-protein diet (0.3 g/kg) combined with supplemental amino acids. The patients were well-motivated RRT candidates who were closely monitored for nearly 1 year. During the course of the study, indications of malnutrition did not occur, and the patients were able to maintain acceptable kidney function (glomerular filtration rate or GFR < 10 mL/min or < 15/mL/min for diabetic patients) (Walser 1999).
- Note: Since 1973, Medicare has picked up 80% of ESRD treatment costs, including the costs of dialysis and transplantation and of some medications. To qualify for benefits, a patient must be insured or eligible for benefits under Social Security or be a spouse or child of an eligible American. Private insurance and state Medicaid programs often cover the remaining 20% of treatment costs.