3 Proven Ways to Stop Lupus Chronic Kidney Disease Progression

posted in Nephritis, kidneys, urinary tract on April 8, 2024 by

Donald Thomas, MD

3 Proven Strategies to Stop Chronic Kidney Disease Progression:

Your Guide to Protecting Your Kidneys

____________________________________________________________________________________

The 3 major groups of controllable risk factors for CKD progression are:

Improve Lifestyle Habits that Worsen Kidney Function

Control Diseases that Worsen Kidney Function

Avoid Substances that Harm the Kidneys

Below is a short checklist to slow kidney function loss

____________________________

What is Chronic Kidney Disease?

Chronic kidney disease (usually abbreviated CKD) refers to permanent damage or permanently reduced kidney function (how well the kidneys remove wastes from the blood and properly return important components).

Causes of chronic kidney disease

Causes of CKD and how well it does, in the long run, can range from a minor birth defect that never gets worse over the lifetime of the person to severe kidney damage from something like severe lupus nephritis (inflammation of the kidneys due to lupus) that rapidly proceeds to complete kidney failure. NOTE: Most lupus nephritis is treatable, can be put into remission, and worsening greatly slowed down. An excellent outcome can especially occur if prompt identification occurs through a kidney biopsy and proper, close treatment is given to a compliant patient who takes their medications religiously. Fortunately, our treatments are markedly better today with belimumab (Benlysta) and voclosporin (Lupkynis) greatly increasing remission rates.

There are many other potential causes of CKD. A short list includes damage from drugs (such as nonsteroidal anti-inflammatory drugs like ibuprofen and diclofenac), severe dehydration, severe infection, and many more. Also, see “Risk Factors Out of Your Control” below.

How we diagnose chronic kidney disease

Evidence for damage must occur for a minimum of 3 months (this separates CKD from acute kidney injury, which is potentially reversible)
Finding any of the following:
- Permanent damage noted on kidney biopsy
- History of kidney transplantation
- Elevated amount of albumin, protein, casts in the urine (casts made of blood cells or fat) in a urine sample.
- Imaging studies showing permanent damage (polycystic disease, persistent backup of urine in the kidneys, small kidneys, or narrowed arteries are examples)
- Persistently decreased kidney function (usually measured in the blood work as the estimated glomerular filtration rate, eGFR. Normal eGFR is greater than 89 mL/min/1.73 m²)

Note: Lupus patients need to know how to collect a reliable urine sample to prevent false abnormalities. Click here to learn how to do so

How do we stage CKD severity?

CKD is staged in severity from grade 1 (normal kidney function) to grade 5 (end-stage needing dialysis and kidney transplantation). The amount of albumin in the urine is also used by kidney specialists (the higher the amount in the urine, the worse it is). I’ll list the grades below by kidney function. I’ll leave out the albumin severities as that complicates things:

CKD grade 1 (CKD 1): eGFR > 89 mL/min/1.73 m²(normal kidney function, but there is some mild permanent damage. This is the easiest to prevent progression by following the recommendations below)
CKD 2: eGFR 60 – 89
CKD 3: eGFR 30 – 59
- Further divided into CKD 3a with eGFR 45 – 59
- CKD 3b with eGFR 30 – 44
CKD 4: 15 – 29 (this group is at the highest risk of going into kidney failure. Following all this device is essential)
CKD 5: < 15 (complete kidney failure requiring dialysis, often called end-stage kidney disease or end-stage renal disease)

________________________________________________
You CAN help slow down the loss of kidney function if you have CKD!
NOTE: In my patients, when I look at my CKD patients, CKD grade 3 is the most common (moderately reduced kidney function).
I have many patients with CKD 3 and CKD 4 who have had stable kidney function without much worsening for over two decades. These tend to be my compliant patients who follow my “Lupus Secrets” and the recommendations below to prevent worsening.
Please try to follow my patients’ footsteps!
_________________________________________________

Controllable Risk Factors

Improve Lifestyle Habits That Worsen Kidney Function

If you have systemic lupus erythematosus or lupus nephritis, read and follow my “Lupus Secrets” recommendations religiously
Salt Intake: Keep sodium (NaCl) less than 3000 mg per day (some experts recommend < 5000 mg, ask your doctor)
Dietary protein: If you have CKD 3-5, eat 600 – 800 mg/kg of body weight per day of protein (ask your doctor for your individualized recommendation)

For CKD 1-2, eat 600 to 1300 mg/kg of body weight per day of protein

Eat a healthy diet:
- A plant-based diet is best
- Minimize meat consumption
- Avoid or minimize ultraprocessed foods
  - Examples of ultraprocessed foods include many breakfast cereals, factory-produced bread, cookies, fruit-flavored yogurt, potato chips and many more
- If CKD 3-5, ask your nephrologist about phosphorus and potassium intake
- Stay well hydrated (usually at least 8-9 glasses of water daily: ask your doctor; some CKD patients do better if they reduce their water intake)
Maintain a healthy body weight:
- A BMI of 25 or less
- Even better is to keep body fat below overweight standards per body composition studies as measured by DXA or other more reliable methods
Perform moderate-intensity exercise for at least 150 minutes weekly
- Avoid a sedentary lifestyle: MOVE!
Do not smoke

Control Diseases that Worsen Kidney Function

If you have lupus nephritis (or any other treatable cause of kidney disease): Take your medications, including hydroxychloroquine, religiously
If you have diabetes: Ask your doctor what your HbA1C goal is, and keep it below that level
Keep your systolic blood pressure (the top number) below 120 (as tolerated if taking BP drugs)
If have high cholesterol, take a statin or use a statin/ezetimibe combination, especially if you are over 50 years old

Avoid Kidney-Harming Substances

Nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve, Advil, naproxen, ibuprofen, meloxicam
Proton pump inhibitors (PPIs) decrease stomach acidity like pantoprazole and lansoprazole. Note that some lupus patients may need to take PPIs, including patients with chronic kidney disease and esophageal dysmotility. Note that PPIs are not proven to worsen kidney function. However, since some studies suggest that PPIs may possibly be associated with CKD, many specialists recommend avoiding them.
Aminoglycoside antibiotics like gentamycin
Contrast media used for imaging studies like CT scans
Chinese herbs

Risk factors out of your control:

Having a disease that increases your risk for CVD (such as lupus)

If you have ever had an episode of decreased kidney function (such as severe dehydration)

Males

Age > 50

Genetics

Being born with a lower number of nephrons (microscopic kidney filters) such as from low birth weight or if born before 36 weeks of gestation

____________________________

For more in-depth information on lupus and chronic kidney disease (CKD):

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

If you enjoy the information from The Lupus Encyclopedia, please click the “SUPPORT” button at the top of the page to learn how you can help.

What are your comments and opinions?

If you have lupus, what has your experience been? What do you recommend for other patients?

Do you have any questions to ask Dr. Thomas?

Please click on “Leave a Comment” above to comment.

Please support “The Lupus Encyclopedia” blog post page

Click on “SUPPORT” at the top of the page to learn how you can support “The Lupus Encyclopedia“

For more in-depth information on 3 Proven Ways to Stop Lupus Chronic Kidney Disease Progression: