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Preventive Nephrology

Introduction

Think of preventive nephrology as "kidney health care before problems start." It's all about protecting your kidneys from damage and catching any issues early when theyโ€™re easier to manage or reverse. Just like brushing your teeth prevents cavities, certain steps can help keep your kidneys working well for life 1

Why is Kidney Prevention Important?

Your kidneys are vital filters. They clean your blood, remove waste and extra fluid, help control blood pressure, balance minerals, and make hormones. Kidney damage often happens slowly and silently โ€“ you might not feel symptoms until a lot of function is lost. Prevention helps avoid serious problems like chronic kidney disease (CKD), dialysis, or kidney transplants 2.

Who is at Higher Risk for Kidney Problems? 3 4

Certain conditions or factors make kidney damage more likely. Talk to your doctor if you have:

  • 1. Diabetes: High blood sugar can damage kidney filters over time.
  • 2. High Blood Pressure (Hypertension): This puts extra strain on delicate kidney blood vessels.
  • 3. Heart Disease: Heart and kidney health are closely linked.
  • 4. Family History: Having a close relative with kidney failure increases your risk.
  • 5. Older Age: Kidney function naturally declines slightly with age.
  • 6. Previous Acute Kidney Injury (AKI): An episode of sudden kidney damage can increase long-term risk.
  • 7. Long-term use of certain medications: Especially pain relievers like NSAIDs (e.g., ibuprofen, naproxen) if used frequently.
  • 8. Obesity: Excess weight increases risk for diabetes and high blood pressure.

Key Strategies for Kidney Prevention:

You can take powerful steps to protect your kidneys:

  • 1. Manage Blood Sugar (If Diabetic): Work closely with your doctor. Keep your blood sugar levels (HbA1c) within your target range through diet, exercise, and medications. This is the single most important step if you have diabetes . 5
  • 2. Control Blood Pressure: Aim for a blood pressure below 130/90 mmHg (or the target your doctor sets). Check it regularly. Medications like ACE inhibitors (e.g., lisinopril, ramipril) or ARBs (e.g., losartan, valsartan) are often used as they protect kidneys specifically . 6
  • 3. Choose Kidney-Friendly Foods: Aim for a blood pressure below 130/90 mmHg (or the target your doctor sets). Check it regularly. Medications like ACE inhibitors (e.g., lisinopril, ramipril) or ARBs (e.g., losartan, valsartan) are often used as they protect kidneys specifically . 7 8
    • Reduce Salt (Sodium): Helps control blood pressure. Limit processed foods, canned soups, and table salt. Aim for less than 2,300 mg daily.
    • Eat Moderate Protein: Very high protein diets can strain kidneys. Ask your doctor if you need to adjust.
    • Focus on Whole Foods: Fruits, vegetables, whole grains, lean proteins.
  • 4. Stay Hydrated (But Don't Overdo It): Drinking enough water helps your kidneys flush toxins. Unless your doctor advises otherwise (like in advanced CKD), drink water when you're thirsty. Clear or light yellow urine is a good sign.
  • 5. Use Medications Wisely 9
    • Avoid Long-term Regular Use of NSAIDs: Drugs like ibuprofen (Advilยฎ, Motrinยฎ) or naproxen (Aleveยฎ) can harm kidneys, especially if you have risk factors. Use them sparingly and discuss alternatives with your doctor.
    • Follow Dosing Instructions: Never exceed recommended doses of prescription or over-the-counter drugs.
    • Tell Your Doctor About ALL Medications: Include supplements and herbs.
  • 6. Maintain a Healthy Weight: Losing even a small amount of weight if you are overweight helps control blood pressure and diabetes risk .<>10
  • 7. Get Regular Physical Activity: Aim for at least 30 minutes most days. Exercise helps control blood pressure, blood sugar, and weight . 11
  • 8. Don't Smoke: Smoking damages blood vessels, including those in your kidneys, and speeds up kidney damage . 12
  • 9. Limit Alcohol: Heavy drinking raises blood pressure and harms health.
  • 10. Get Screened Regularly: If you have risk factors (like diabetes or high blood pressure), your doctor should check:
    • Blood Pressure: At every visit.
    • Blood Tests: Creatinine and eGFR (estimates your kidney filtering rate).
    • Urine Tests: Albumin-to-creatinine ratio (ACR) to detect early signs of kidney damage (small amounts of protein leaking) . 13

Small Steps, Big Impact: 10

You don't have to change everything overnight. Focus on one or two healthy habits to start with. Partner with your doctor โ€“ they can help assess your personal risk and create a prevention plan just for you.

Key Takeaways:

  • Prevention focuses on keeping kidneys healthy.
  • Controlling diabetes and high blood pressure is crucial.
  • Healthy eating, staying active, and wise medication use protect your kidneys.
  • Regular check-ups are essential if you have risk factors.
  • Talk to your doctor about your kidney health!

References

  1. 1. Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3(1):1-150.
  2. 2. Levey AS, Coresh J. Chronic kidney disease. Lancet. 2012;379(9811):165-180.
  3. 3. National Kidney Foundation. About Chronic Kidney Disease. https://www.kidney.org/atoz/content/about-chronic-kidney-disease (Accessed October 26, 2023).
  4. 4. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, et al. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet. 2013;382(9889):339-352.
  5. 5. American Diabetes Association. 11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetesโ€”2023. Diabetes Care. 2023;46(Suppl 1):S191-S202.
  6. 6. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Coll Cardiol. 2018;71(19):e127-e248.
  7. 7. McMahon EJ, Campbell KL, Bauer JD, et al. Altered dietary salt intake for people with chronic kidney disease. Cochrane Database Syst Rev. 2021;6(6):CD010070.
  8. 8. Clark WF, Sontrop JM, Huang SH, et al. Hydration and Chronic Kidney Disease Progression: A Critical Review of the Evidence. Am J Nephrol. 2016;43(4):281-292.
  9. 9. Harirforoosh S, Asghar W, Jamali F. Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications. J Pharm Pharm Sci. 2013;16(5):821-847.
  10. 10. Afshinnia F, Wilt TJ, Duval S, et al. Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts. Nephrol Dial Transplant. 2010;25(4):1173-1183.
  11. 11. Howden EJ, Coombes JS, Isbel NM. The role of exercise training in the management of chronic kidney disease. Curr Opin Nephrol Hypertens. 2015;24(6):480-487.
  12. 12. Orth SR, Hallan SI. Smoking: a risk factor for progression of chronic kidney disease and for cardiovascular morbidity and mortality in renal patients--absence of evidence or evidence of absence? Clin J Am Soc Nephrol. 2008;3(1):226-236.
  13. 13. National Institute for Health and Care Excellence (NICE). Chronic kidney disease: assessment and management. NICE guideline [NG203]. Published 25 August 2021 https://www.nice.org.uk/guidance/ng203(Accessed October 26, 2023).

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