Causes And Risk Factors For Chronic Kidney Disease

Chronic kidney disease (CKD) has become an important public health problem that endangers human health worldwide. However, the awareness and diagnosis rates of CKD in my country are generally low, which is in sharp contrast to its high prevalence. The Global Burden of Disease Study shows that the global CKD prevalence was 9.1% in 2017. A cross-sectional epidemiological survey in my country shows that the prevalence of CKD in people over 18 years old is 10.8%, and there are 132 million CKD patients in my country. With the aging of my country's population and the increasing incidence of diseases such as diabetes and hypertension, the incidence of CKD has also shown a rising trend.

Click to Cistanche for kidney disease

Chronic kidney disease is defined as chronic renal structural and functional disorders caused by various reasons (history of kidney damage for more than 3 months), including normal and abnormal pathological damage to glomerular filtration rate, abnormal blood or urine components, and abnormal imaging examinations, or unexplained decrease in estimated glomerular filtration rate (eGFR) [eGFR <60ml/(min·1.73m2)] for more than 3 months.

The main risk factors for CKD include diabetes, hypertension, cardiovascular disease, the elderly, sociodemographic factors (such as genetics, gender, race), comorbidities (such as obesity, non-alcoholic fatty liver disease, dyslipidemia, hyperuricemia), history of acute kidney injury (AKI) or family history of kidney disease, long-term use of nephrotoxic drugs (such as antipyretics, Chinese herbal medicines containing aristolochic acid, immunosuppressants such as cyclosporine A or tacrolimus, lithium, new targeted anti-tumor drugs such as immune checkpoint inhibitors), and environmental factors (such as exposure to atmospheric particulate matter and gaseous pollutants, ambient temperature), etc. In clinical practice, high-risk groups for CKD need to pay attention to monitoring and evaluating their kidney damage indicators to improve the diagnosis rate of CKD and facilitate early intervention.

The main factors that cause the progression of chronic kidney disease are the following:

Diabetes

Diabetic nephropathy is one of the most common microvascular complications of diabetes. Renal hemodynamic changes and metabolic abnormalities caused by hyperglycemia are the pathological basis of renal damage. Whether it is type 1 or type 2 diabetes, 25% to 40% of patients may have kidney involvement. Among patients with type 2 diabetes, 5% have already developed renal damage at the time of diagnosis. Renal hemodynamic changes and metabolic abnormalities caused by hyperglycemia are the pathological basis of renal damage. It is recommended to control the target value of glycosylated hemoglobin (HbA1c) below 7.0%. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have renal protective effects in addition to hypoglycemia. In addition to significantly reducing cardiovascular events in diabetic patients, preliminary evidence shows that glucagon-like peptide-1 (GLP-1) receptor agonists can improve renal prognosis.

Hypertension

Hypertension is a common complication of CKD. It can also cause renal damage and promote the progression of CKD. It can also cause target organ damage such as the heart, brain and peripheral blood vessels, and make CKD patients have a poor prognosis. Regardless of whether diabetes is present, when the urine albumin/creatinine ratio (UACR) is ≤30mg/g, blood pressure should be maintained at ≤140/90mmHg; when UACR＞30mg/g, blood pressure should be controlled at ≤130/80mmHg. Choose antihypertensive drugs reasonably according to the condition and achieve individualized treatment. Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) are the first choice for hypertensive patients with CKD and proteinuria.

Proteinuria

Proteinuria is defined as urine protein > 150 mg or UACR > 30 mg/g. UACR between 30 and 300 mg/g is called microalbuminuria, and > 300 mg/g is called macroalbuminuria. Excessive albumin and other proteins can damage the glomerular filtration membrane and tubular cells through glomerular filtration and tubular reabsorption, promoting glomerular sclerosis and tubular interstitial fibrosis. The target of urine protein control for diabetic CKD patients should be UACR < 30 mg/g, and the target of urine protein control for non-diabetic CKD patients should be UACR < 300 mg/g.

Renin-angiotensin-aldosterone system inhibitors (RAASi): ACEI, ARB or mineralocorticoid receptor antagonist (MRA) have antihypertensive and renal protective effects independent of antihypertensive effects, but blood creatinine levels need to be monitored. A variety of primary or secondary glomerular diseases, whose pathogenesis is mainly mediated by abnormal immune response, require the use of glucocorticoids, immunosuppressants, and biological agents to achieve sustained remission of proteinuria.

Dyslipidemia

Dyslipidemia is an important factor promoting the progression of CKD, and is also a major risk factor for cardiovascular and cerebrovascular diseases, renal atherosclerosis, and target organ damage in CKD patients. Elevated blood lipid components and abnormal lipid components such as oxidized low-density lipoprotein and glycated low-density lipoprotein can damage glomerular intrinsic cells and tubular-interstitial tissue, promote the increase of extracellular matrix production, and lead to glomerular sclerosis and renal interstitial fibrosis. The low-density lipoprotein cholesterol (LDL-C) level of extremely high-risk patients with a history of atherosclerotic cardiovascular disease or eGFR <60ml/(min·1.73m2) should be <1.8mmol/L, and the LDL-C level of other patients should be <2.6mmol/L. Apply lipid-lowering drugs on the basis of changing lifestyle.

Hyperuricemia

Hyperuricemia is a risk factor for cardiovascular events and an independent risk factor for renal impairment. It can cause AKI, CKD, and uric acid nephrolithiasis, and accelerate the progression of CKD. Patients with secondary hyperuricemia in CKD should be treated with intervention when the level is >480μmol/L. Drugs should be selected and dosages adjusted according to the classification of hyperuricemia and eGFR levels.

Nephrotoxic drugs

Many antibiotics, analgesics, anti-tumor drugs, contrast agents, and traditional Chinese medicines are nephrotoxic. Long-term and excessive use should be avoided. Attention should be paid to adjusting the dosage of CKD patients according to eGFR levels. Many drugs are cleared by glomerular filtration or tubular secretion. Reduced glomerular filtration rate can lead to accumulation of drugs or their metabolites. Patients with eGFR <45ml/(min·1.73m2) have an increased risk of acute kidney injury induced by some drugs. Drugs with potential nephrotoxicity and renal excretion should be suspended or reduced.

Bad living habits

Obesity, high sodium, high protein diet, smoking, etc. will accelerate the progression of CKD. Therefore, CKD patients should exercise reasonably, moderately and regularly, limit sodium intake (should be less than 2.3g/d), and quit smoking to reduce proteinuria and delay progression to the end stage.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.