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Inflammatory conditions of the kidneys can present many challenges, whether part of a systemic condition such as lupus or a condition specific to the kidney such as IgA nephropathy or focal segmental glomerulosclerosis (FSGS). These conditions are often resistant to treatment and require long-term strategies and lifestyle changes to manage. While many patients will quickly make progress in reducing kidney inflammation, ongoing diligence is required to bring these conditions into full remission.
While there are specific therapies targeting different types of kidney inflammation, here are some general guidelines that can help reduce inflammation in the kidneys. Protein in the urine is key to recognizing inflammation in the kidneys. There can be varying degrees of edema, depending on how much sodium is consumed, but foamy urine is a bad sign and indicates inflammatory changes in the kidney. Where there's smoke, there's fire, and foaminess of the urine is a clear indicator of inflammation. Simple steps can help quell the inflammation in the kidneys, and patients will be able to gauge their progress by noting change in their urine.
Mainstream treatment of nephritis generally involves the use of ACE inhibitors or ARBs to reduce blood pressure. Patients are also given statins and steroids or other immune suppressants. Generally there are no dietary guidelines given until the nephritis has progressed to end-stage renal disease and they are facing the prospect of dialysis.
As the kidneys are one of the fattiest tissues of the body, dietary intervention for nephrotic syndrome should aim to first eliminate all harmful fats from the diet. All synthetic fats such as margarine and hydrogenated oils must be stopped. Cooking methods should include baking and steaming but not frying or grilling. Omega-6 fatty acids in the diet will also increase inflammation.1 Kidney patients do well eliminating all cooking oils high in omega-6 fatty acids, including canola, corn, vegetable, sesame, safflower, sunflower, and soybean oil. Instead, I advise patients to use flaxseed oil raw, olive oil raw or low temperature, macadamia oil for medium temperature, and, if they must use high heat, butter or coconut oil.
Although many kidney patients eat nuts as they shift to a more vegetable-based diet, the high levels of omega-6 fatty acids in most nuts (with the exception of walnuts and macadamias) do not make them good dietary staples. I do not recommend almond milk or soy milk as substitutes for dairy in the diet. If meat and dairy products are part of the diet, grass-fed products will have a much more favorable omega-6 to omega-3 ratio.2 Wild-caught salmon and mackerel are also helpful additions to the diet.
Therapeutic use of omega-3 fatty acids can help reduce inflammation and proteinuria.3 Patients will often note very quickly a marked decrease in foaminess of the urine. The addition of flaxseed oil to the diet can be extremely useful. These products often come in a clear version and a high-lignan product. I advise patients to choose the clear flaxseed oil, as high-lignan products are higher in phosphorus. Fish oil products can also help arrest the continued leakage of protein. These products should be an EPA/DHA blend. Krill oil should be avoided, as these products are also high in phosphorus. Cod liver oil is not recommended because it is high in vitamin A, and patients with nephrotic syndrome often have elevated levels of vitamin A.4 Algae products are also not desirable for nephrotic syndrome, as they do not have a favorable balance of fatty acids, with a much higher content of DHA compared with EPA. Dosing of omega-3 supplements can vary depending on the degree of proteinuria. Often patients can note an immediate difference in foaminess of urine, but urine strips can help quantify a decrease in albumin in the urine.
Besides reducing protein in the urine, therapy for kidney inflammation should address damage to the parenchymal tissue of the kidneys. As nephrotic syndrome progresses, often the kidney tissue itself becomes progressively scarred. Coconut oil can help arrest this insidious breakdown of the nephrons in the kidney and preserve functional renal tissue.5 Many patients are hesitant about incorporating a saturated fat into their diet; however, the kidneys are the largest stores of saturated fat in the body and coconut oil can be an essential addition to the daily diet.
Another potentially useful fatty acid for the nephrotic patient is conjugated linoleic acid (CLA). While this trans fat does not stop proteinuria directly, it may help prevent the cachexia of nephrotic syndrome, enabling the patient to retain lean body weight and extending survival.6 Found in grass-fed red meat, CLA will probably be low in the nephrotic patient's diet and supplementation may be helpful. With advanced renal disease, often the patient will experience elevated parathyroid hormone (PTH) and a loss of bone density. CLA again may be of benefit by reducing PTH.7
A low-protein diet is of benefit to reducing protein loss in the urine. However, overzealous patients should be advised to avoid self-induced kwashiorkor. A loss of muscle mass is associated with poor survival in kidney patients.8 As a general rule, I advise patients to consume 0.8 g of protein per kg of body weight. For children or those who have already lost muscle mass, 1.0 g of protein per kg of body weight, and those with advanced kidney disease who are close to needing dialysis, 0.6 g of protein per kg of body weight per day. These numbers may also be adjusted if the patient is carrying more adipose tissue.
The semivegetarian diet is usually a good option for kidney patients. Rice and beans can be good staples, but to avoid chronic amino acid deficiencies, the diet should include a small amount of animal protein.9 This may be especially true for kidney patients dealing with anemia. Hemp protein is also a good choice for patients with nephrotic syndrome. With a high omega-3 content, it may also may slow the progression of kidney disease and prevent the secondary heart enlargement that often accompanies chronic kidney disease.10
Cleaning up the diet with chronic kidney inflammation involves removing all processed food, particularly hydrogenated oil, high-fructose corn syrup, and phosphoric acid. Genetically modified foods, especially GMO corn, can aggravate the kidneys.11 Fast foods are especially laden with phosphate-based preservatives and must be eliminated.12 Artificial sweeteners are also toxic to the kidney.13 Gluten may or may not play a role in kidney inflammation. Taking gluten out of the diet is clearly helpful for IgA nephropathy, but may not have much impact on FSGS or other types of kidney inflammation.14
Many nephrotic patients rely on coffee to deal with the chronic fatigue of renal disease. However, coffee will increase inflammation and proteinuria. This is especially true for patients with FSGS.15 Most kidney patients will find that their urine looks considerably less foamy after cessation of coffee. This effect of coffee is most likely not due to caffeine alone, since green tea, with antioxidant properties, will help reduce proteinuria. 16
High-antioxidant foods that I recommend to patients for kidney support include blueberries, grapes, cherries, pomegranate, green tea, hibiscus tea, lemons, apples, and pears.17-20 Celery can help with blood pressure and reduce uric acid. Beet juice is a source of antioxidants and can help blood pressure.21 Fermented foods can also help the kidneys indirectly by promoting a healthy gastrointestinal tract.
Cholesterol is often exceedingly high with nephrotic syndrome, as the liver responds to the loss of protein in the urine by producing endogenous cholesterol. Dietary attempts to minimize cholesterol will be of little consequence unless the root cause of proteinuria is addressed. Standard treatment of hypercholesterolemia in the nephrotic patient is a statin medication, despite the nephrotoxicity of these drugs.22 An alternative to statin medications is berberine, which not only lowers cholesterol dramatically but also has a protective effect on the kidneys.23,24
Other medications that can aggravate the kidneys include proton pump inhibitors, NSAIDs, antibiotics, and immune suppressants. Offering the patient alternative solutions to reduce reliance on these drugs can help reduce the stress on the kidneys. Often patients need to understand that the stomach is supposed to be acidic and this is the medium wherein proteolytic enzymes work best. Apple cider vinegar or aloe vera can help with the symptoms of acid reflux and may reduce the need for proton pump inhibitors.
Given their high degree of nephrotoxicity, patients should be encouraged to step down from NSAIDs whenever possible.25 Reliance on NSAIDs for musculoskeletal pain can often be reduced with an anti-inflammatory diet. Patients should also be aware of natural analgesics and acupuncture for pain modulation. Aspirin can also be a nephrotoxin despite the benefit of antiplatelet activity.26 Renal patients can safely obtain the anticoagulating effects of fish oil or ginger instead.
Ginger may also benefit the renal patient who finds it necessary to use antibiotics. Gentamicin can induce inflammation and necrosis in the kidney. Ginger extract has been shown to reduce kidney damage and restore normal levels of creatinine, BUN, and uric acid with gentamicin.27
Immune suppressants are often used in the treatment of nephrotic syndrome. Patients are usually eager to step down from steroids, given the cushingoid effects and concerns about long-term bone density. Calcineurin inhibitors, including cyclosporine and tacrolimus, are also used to reduce inflammation in the kidneys. While these medications can reduce proteinuria, they are also nephrotoxic and increase rates of malignancy. If the patient uses this approach for intractable proteinuria, naturopathic medicine can be a useful adjunct, as green tea and garlic can reduce the nephrotoxicity of these medications.28,29
Infections are commonplace among patients with nephrotic syndrome, be they UTIs, URIs, or skin infections. Not only are many patients treated with immune suppressants, but low albumin in the blood will also suppress immunity. Zinc, an important mineral for immunity, is lost in the urine with nephrotic syndrome.30 Supplementing zinc will not only support the immune response, but it may also actually help prevent relapses after remission has been achieved.31
I do not recommend vaccination to kidney patients and in practice have had many patients note an aggravation of proteinuria immediately following a vaccine. A study of a murine model of IgA nephropathy looked at the effects of Saccharomyces boulardii on this condition. In order to test with a control and treatment group, inflammation had to be induced in both populations. And the inflammation was directly induced with a vaccine.32 Whether this effect is due to activation of the immune system directly or from adjuvants, I urge kidney patients to educate themselves on both sides of this controversy. Nephrologist Dr. Suzanne Humphries has done extensive research on this topic and I often refer patients to her work.
Local or systemic inflammation often stirs up the immune system to aggravate proteinuria. Many patients with underlying inflammation in their kidneys report that during a cold or sinus infection, their urine comes out especially foamy. Musculoskeletal injuries can have the same effect of exacerbating proteinuria. Supplements of quercetin, curcumin, bromelain, and other enzymes are useful to immediately reduce the foaminess of the urine. Modified citrus pectin can also help reduce the inflammation of kidney disease.33
Long-term lifestyle changes can help address the inflammation associated with nephrotic syndrome. Lack of sleep is one of the best predictors of proteinuria.34 Administering exogenous melatonin can not only reduce proteinuria, but can improve kidney function.35 According to Traditional Chinese Medicine (TCM), there is a relationship between sleep and the kidneys, and stress in the kidneys may be noted with dark circles under the eyes. Getting to bed early is an essential part of a healthful lifestyle for kidney patients, and often a difficult challenge for many who struggle with insomnia.
Weight loss is often essential to reduce stress on the kidneys. With a greater body area to service, the kidneys will be chronically overworked, and obesity can result in hypertension. Even if the patient is not diabetic, the elevated serum glucose and insulin will increase kidney stress. Cytokines secreted from adipose tissue will also increase inflammation.
In TCM the nephrotic patient is characterized as being cold and damp. Many kidney patients have noted to me severe cold intolerance and that their urine looks much foamier when they feel chilled. Eating cooked food in season and dressing warmer than would seem necessary is often helpful. Moxabustion can also be a helpful adjunct therapy.
With dietary and lifestyle changes, it is possible to reduce inflammation and prevent irrevocable damage to the kidneys. If the inflammatory process is caught early enough, the patient will be able arrest further damage to the kidneys. Even very late in the process, a naturopathic approach to inflammation may delay the need for dialysis.
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