We combed through multiple medical journals looking for the latest research on the Integrative approach to kidney health. We know your time is valuable, so we curated and summarized these studies for you. Welcome to the InKidney May Research and News.
May Research and News
Lifestyle interventions do indeed work
Poor dietary patterns and low physical activity levels are important lifestyle-related factors that contribute to chronic kidney disease (CKD) and its progression.
In a systematic review and meta-analysis published in Kidney Medicine, researchers evaluated the impact of diet, exercise, and other lifestyle-related interventions on risk factors for and progression of chronic kidney disease (CKD) and quality of life.
The analysis included 68 randomized controlled trials in individuals with CKD.
Twenty-four studies were dietary interventions, 23 were exercise, 9 were behavioral, 1 a hydration intervention, and 11 involved multiple components.
Lifestyle interventions resulted in significant improvements in:
1. Creatinine
2. 24-hour albuminuria
3. Systolic and diastolic blood pressure
4. Body weight
5. Quality of life (mostly sleep, fatigue, and pain)
Lifestyle interventions did not result in significant changes in the estimated glomerular filtration rate (eGFR)!
You would wonder how the study shows improvement in creatinine with lifestyle interventions but not in eGFR, which is calculated from creatinine. The authors explained that the changes in creatinine “were not clinically significant.”
Lifestyle interventions resulted in significant improvements in creatinine (-0.43mg/dL, 95% CI: -0.74, -0.11, p=0.008). In our minds, a 0.4 drop in creatinine is significant, and it beets worsening creatinine at any time.
Finally, the meta-analysis demonstrated that exercise interventions resulted in the greatest improvements in eGFR and creatinine. While the greatest effects of dietary interventions were albuminuria and systolic blood pressure.
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The four-hit hypothesis in IgA Nephropathy
Immunoglobulin A (IgA) nephropathy (IgAN) is the most common primary glomerulonephritis worldwide.
The ongoing theory about the root cause of IgAN is the “four-hit hypothesis.” This hypothesis suggests that four hits cause the development of IgAN:
1. Increased circulating levels of an abnormal IgA1 (gd-IgA1)
2. The production of autoantibodies against this abnormal IgA1
3. The formation of immune complexes with anti-gd-IgA1 antibodies
4. The deposition of these immune complexes in the glomerular mesangium leads to kidney
The site of gd-IgA1 production is presumed to be the Peyer’s patches of the gut and mesenteric lymph nodes.
No one knows why patients start producing this abnormal IgA1. However, an interplay between genetics and the environment may play a role.
We believe that environmental factors (dysbiosis, virus, infection, etc.) may trigger the formation of abnormal IgA1 in genetically predisposed patients.
This review article provides very insightful details about the role of innate and adaptive immune mechanisms involved in IgAN for those who like to dig deeper. It is a free-access article.
Speaking of IgA nephropathy
A recent study in CJASN looked at the long-term outcomes for patients with IgAN. The study included 2,299 adults and 140 children from the UK National Registry of Rare Kidney Diseases.
50% of patients reached kidney failure or died over a median follow-up of 5.9 years.
The median kidney survival was 11.4 years, with an average age at kidney failure or death was 48 years.
Most patients progressed to kidney failure within 10-15 years.
Time-averaged proteinuria was significantly associated with worse kidney survival and rapid kidney function loss.
Why is this important? Besides knowing the natural progression of IgAN, many pharmaceutical companies are developing drugs for managing IgAN. They are targeting proteinuria as a surrogate marker for the progression of IgAN.
You should know that this study is sponsored by Travere Therapeutics, the maker of the new IgAN drug, Sparsentan. One of the authors works in Travere Therapeutics, and others are consultants for it.
Overweight moms are more likely to have children with congenital abnormalities in their kidneys and urinary tract
In a study of 4,619 newborns enrolled during 2012–2020 from a hospital in Taiwan, maternal risk factors before and during pregnancy were compared in children with and without congenital anomalies of the kidney and urinary tract (CAKUT).
In total, 73 (1.6%) cases of CAKUT in offspring were identified.
Maternal overweight before pregnancy (BMI ≥ 24 kg/m2) was an independent risk factor for CAKUT in offspring.
There were no observed associations of pregestational diabetes and gestational diabetes with CAKUT in offspring were observed.
“Maternal obesity before pregnancy is associated with CAKUT in offspring and should be addressed to ensure better outcomes,” note the authors of the Pediatric Nephrology study.
This study highlights the role of epigenetics in kidney health and disease.
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