Do Patients With Kidney Disease Want To Reduce Urinary Protein? Don’t Just Know ARB!
May 10, 2024
Controlling urinary protein is one of the important strategies to delay the progression of kidney disease
Generally speaking, a 24-hour urine protein quantification of less than 150 mg is within the normal range. In patients with kidney disease, the 24-hour urine protein quantification should be controlled below 500 mg. Currently, clinically, the drug regimens for lowering urinary protein generally include the following:
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medical treatment
①ACEI/ARB
ACEI/ARB (primer and sartan drugs) can not only lower blood pressure, but also reduce intraglomerular pressure, reduce urinary protein, and delay the progression of renal function. For CKD patients with severe proteinuria who do not receive dialysis, it is recommended to use ACEI or ARB treatment; for patients with moderate proteinuria and diabetes, it is recommended to use ACEI or ARB treatment.
②SGLT2i
Although SGLT2i is a hypoglycemic drug, it can protect kidney function through multiple mechanisms such as repairing "tubuloglomerular feedback", improving glomerular hyperfiltration, reducing intraglomerular pressure, improving local hypoxia, and reducing tubular load. , to reduce urinary protein.
Regardless of whether CKD patients have diabetes or not, SGLT2i can be used for treatment. The main drugs are dapagliflozin and empagliflozin.
Dapagliflozin and empagliflozin 10 mg, once a day, take on an empty stomach or after eating. Dosing recommendations for patients with renal impairment are as follows:
③ Mineralocorticoid receptor antagonist (MRA)
MRA protects the kidneys by antagonizing mineralocorticoids and their receptors to reduce oxidative stress, inflammatory response, and pro-fibrotic effects caused by excessive activation of mineralocorticoid receptors.
For CKD patients with diabetes and proteinuria who have been treated with the maximum tolerated dose of ACEI/ARB and/or SGLT2i, MRA can be added as appropriate, and it is recommended that non-steroidal MRA (fenelidone) be given priority.
The starting dose of fenelidone needs to be determined based on eGFR and serum potassium levels:
If serum potassium is >5.0mmol/L or eGFR is <25ml/(min·1.73m2), fenelidone is not recommended;
When serum potassium ≤5.0mmol/L and eGFR≥60ml/(min·1.73m2), the standard dose of 20 mg/d is recommended;
When serum potassium ≤5.0mmol/L, 25ml/(min·1.73m2)≤eGFR<60 ml/(min·1.73m2), it is recommended to start with 10mg/d.
Serum potassium and eGFR levels should be monitored within 4 weeks of initiating fenelidone therapy:
If the serum potassium is ≤4.8 mmol/L and the eGFR decreases by ≤30% compared with the last test, the dose can be increased to 20 mg/d or maintained at 20 mg/d;
If the serum potassium is 4.8~5.5 mmol/L or the eGFR decreases by >30% compared with the last test, the current dose of 10 or 20 mg/d should be maintained;
If serum potassium is >5.5 mmol/L, fenelidone treatment should be suspended.
At the same time as drug treatment, the diet of patients with kidney disease cannot be neglected.
High quality low protein diet
Protein is very important for maintaining the body's tissue renewal and body functions. Most patients with chronic kidney disease suffer from protein loss. Excessive protein intake will increase the burden on the kidneys of patients with chronic kidney disease and accelerate the progression of the disease. Therefore, the type and amount of protein in the food intake of patients with chronic kidney disease should be selected according to their disease stage. High-quality protein should account for more than 50% of the total protein. High-quality protein is usually rich in animal foods and soybeans. .
The protein intake of patients with CKD stages 1~2 should be controlled at 0.8~1.0g/(kg·d); non-dialysis patients with stable metabolism in CKD stages 3~5 should limit protein intake in their diet, and the proportion of plant protein intake can be increased appropriately. , to delay disease progression.
Eat less salt and control oil
"Food and Nutrition Guidelines for Adults with Chronic Kidney Disease (2024 Edition)" Controlling salt intake in the diet will help improve blood pressure and reduce proteinuria and edema in patients with chronic kidney disease. It is recommended that patients with chronic kidney disease should have a daily salt intake of no more than 5g; for chronic kidney disease patients with edema, a low-salt diet should be implemented and the daily salt intake should not exceed 3g.
Avoid eating smoked, barbecued, pickled and other over-processed foods, limit the intake of soy sauce, monosodium glutamate, chicken essence, various sauces and other condiments, and try to choose natural flavors such as hawthorn, lemon, pepper, Sichuan peppercorns, vinegar, etc.
Patients with kidney disease should try to quit smoking
Smoking is an independent risk factor for CKD patients. Studies have shown that smokers have a higher risk of albuminuria than non-smokers. Therefore, it is recommended that CKD patients quit smoking to reduce albuminuria and delay disease progression.
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.
