Related Terms

• Blood urea nitrogen test, BUN test, CAPD, CCPD, continuous ambulatory peritoneal dialysis, continuous cycling peritoneal dialysis, cyclosporine toxicity, dialysis, diuretic, diuresis, Fanconi-syndrome, hemodialysis, gentamicin toxicity, glomerulonephritis, glomerulosclerosis, heat exhaustion, hypercalcemia, hyperkalemia, hypophosphatemia, IgA nephropathy, kidney cancer, kidney disease, kidney disorders, kidney failure, kidney stones, renal calculi, lupus nephritis, nephritic syndrome, nephrotoxicity, renal colic, renal disease, renal failure, Type II nephritic syndrome, urinary calculi, urolithasis.

Background

• Kidney disorders occur when the kidneys do not function normally.

• The kidneys, a pair of organs located on the left and right side of the abdomen, are an essential component of the urinary tract. The kidneys are responsible for removing toxins, chemicals, and waste products from the blood. These organs also regulate acid concentration and maintain water and electrolyte balance in the body by excreting urine.

• Nephropathy is a term that is used to describe kidney damage. Many diseases and disorders may lead to nephropathy or even kidney failure.

• Examples of kidney disorders include Fanconi syndrome, glomerulonephritis, focal segmental glomerulosclerosis (FSGS), kidney cancer, kidney stones, and nephrotoxicity. These disorders may develop for a wide variety of reasons. Some disorders may be caused by exposure to toxic chemicals or medications, while others may be inherited.

• Treatment and prognosis varies depending on the type and severity of the kidney disorder. Most patients are able to recover completely if they are diagnosed and treated in the early stages of the disease. However, if left untreated, many disorders may lead to kidney failure, which is a fatal condition, unless the patient receives a kidney transplant.

Common Types and Causes of Kidney Disorders

• Fanconi syndrome: Fanconi syndrome occurs when the tubes in the kidneys do not work properly. Normally, the kidneys filter out waste products in the blood and regulate the amount of salt and other electrolytes in the body. They also reabsorb important molecules, including glucose, amino acids, small proteins, water, calcium, potassium, magnesium, bicarbonate, and phosphate. Patients with Fanconi syndrome are unable to reabsorb these molecules. As a result, the blood becomes overly acidic, and patients typically experience excessive thirst, increased urination, bone disease, and stunted growth.

• Fanconi syndrome may be caused by inherited disorders. For instance, cystinosis galactosemia, glycogen storage disease, hereditary fructose intolerance, Lowe syndrome, Wilson disease, tyrosinemia, medullary cystic disease, and vitamin D dependency, have been shown to cause Fanconi syndrome.

• In addition, some environmental factors may cause patients to develop Fanconi's syndrome later in life. For instance, exposure to heavy metals (e.g. cadmium, lead, mercury, platinum, or uranium), certain drugs (e.g. gentamicin), other substances (e.g. Lysol®, paraquat, toluene, and lysine supplements), and kidney transplantation may cause Fanconi syndrome.

• Glomerulonephritis: Glomerulonephritis is a kidney disease that occurs when the kidneys are unable to properly remove waste and excess fluids from the body.

• If the condition develops suddenly over a short amount of time it is considered acute. If glomerulonephritis develops gradually over a longer period of time, it is considered chronic.

• Sometimes glomerulonephritis occurs by itself. In some cases, the condition may be caused by other illnesses, such as an autoimmune disease called lupus, a lung and kidney disease called Goodpasture's syndrome, diabetes, or immunoglobulin A (IgA) nephropathy. IgA nephropathy occurs when a protein, called immunoglobulin A, builds up inside the kidneys. Glomerulonephritis may also develop with diseases that cause inflamed blood vessels (vasculitis). Examples of vasculitis disorders that may cause glomerulonephritis include polyarteritis and Wegener's granulomatosis.

• Glomerulonephritis may also develop after a bacterial or viral infection, such as streptococcus, HIV (human immunodeficiency virus), hepatitis B, or hepatitis C.

• Focal segmental glomerulosclerosis (FSGS): Focal segmental glomerulosclerosis (FSGS) is a type of glomerular disease (disease that affects the glomeruli) that can cause permanent kidney disease in children and adults. It affects kidney function by attacking the glomeruli, the tiny structures inside the kidneys where blood is filtered. The term glomerulosclerosis is used to describe the scarring or hardening of the tiny blood vessels inside the kidneys. Consequently, protein and sometimes, red blood cells, leak into the urine.

• The most common sign of FSGS is nephrotic syndrome, which is characterized by fluid in the body tissues that causes swelling (edema), excess protein in the urine (proteinuria), hypoalbuminemia (abnormally low levels of albumin, which is normally the most plentiful protein in the blood), and high cholesterol.

• The cause of FSGS is usually unknown. However, some cases may be inherited.

• Kidney cancer: The kidneys may develop cancer. The most common type of kidney cancer in adults is called renal cell carcinoma, which starts inside the cells that line tubes in the kidneys. The most common type of kidney cancer in children is called Wilms' tumor.

• The exact cause of kidney cancer remains unknown. However, researchers believe that several factors, including smoking, obesity, high blood pressure, exposure to environmental toxins (e.g. asbestos), and exposure to radiation may increase a patient's risk of developing kidney cancer. In addition, patients who are undergoing dialysis or who have a history of von Hippel-Lindau disease or bladder cancer have an increased risk of developing kidney cancer.

• If diagnosed and treated quickly, most patients experience a full recovery. However, if left untreated, kidney cancer may spread to other parts of the body.

• Kidney stones (renal calculi): Kidney stones (also called renal calculi, urinary calculi, urolithiasis, or nephrolithiasis) usually develop when the urine becomes too concentrated. As a result, minerals and other substances in the urine form hard crystals on the inner surfaces of the kidneys. Overtime, these crystals may combine to form a small, hard mass, or stone. There are four different types of kidney stones: calcium stones (also called calcium oxalate stones), struvite stones, uric acid stones, and cystine stones.

• Calcium stones are the most common type of kidney stones, accounting for 80% of cases. Calcium stones develop when there are high levels of calcium (hypercalcemia) and oxalate in the blood. Patients who consume excessive amounts of vitamin D or have overactive thyroids may have high levels of calcium in the blood. Vitamin D is found in many foods, including fish, eggs, fortified milk, and cod liver oil. The sun also helps the body produce vitamin D. Patients who consume large amounts of oxalic acid or undergo intestinal bypass surgery may have high levels of oxalate in the blood. Oxalic acid is found in some plants, such as spinach, alfalfa, angelica, black haw bark, and rhubarb.

• Struvite stones are usually caused by chronic urinary tract infections. The bacteria that cause these infections release enzymes that increase the amount of ammonia in the urine. This excess ammonia may form large, sharp stones that can potentially damage the kidneys.

• Uric acid stones form when there is excess uric acid in the urine. Uric acid is a waste product that is formed when the body breaks down proteins. These stones are usually caused by a cancer treatment called chemotherapy. It may also develop in patients who eat high-protein diets. Some patients are genetically predisposed to develop uric acid stones.

• Cystine stones develop in patients who have an inherited disorder called cystinuria. This disorder causes the kidneys to release too many amino acids, which then form stones.

• Nephrotoxicity: Nephrotoxicity is a term used to describe toxic damage in the kidneys. When the kidneys become damaged, they are unable to remove excess fluid and waste from the blood. As a result, the electrolytes in the blood, including potassium and magnesium, will build up to toxic levels. When there are high levels of potassium in the blood, the condition is called hyperkalemia.

• Certain medications, such as cyclosporine (Neoral® or Sandimmune®), tenofovir (Viread®), and gentamicin (Garamycin®), may have a poisonous effect on the kidneys. This may occur if patients take doses that are too high. Patients with kidney disease have an increased risk of developing nephrotoxicity because their kidneys are already weakened.

Signs and Symptoms

• Fanconi syndrome: Symptoms of Fanconi syndrome typically include increased urination (diuresis), excessive thirst, dehydration, constipation, anorexia nervosa, and vomiting. Patients usually have high levels of sugar, phosphate (hypophosphatemia), calcium, uric acid, amino acids, and protein in the urine. High levels of chloride and low levels of phosphate and calcium in the blood are also common. As a result of these electrolyte imbalances, patients may develop bone disease.

• Focal segmental glomerulosclerosis (FSGS): Common symptoms of focal segmental glomerulosclerosis (FSGS) include fatigue, nausea, headache, foamy urine, weight gain, and poor appetite.

• Patients with FSGS typically develop nephrotic syndrome, which is characterized by fluid retention that causes swelling (edema), foamy urine (caused by high levels of protein in the urine, also called proteinuria), abnormally low levels of albumin in the blood (hypoalbuminemia), and high cholesterol (hyperlipidemia). Edema generally develops over a few weeks, but initial symptoms may appear suddenly in some patients, with weight gain of 15 to 20 or more pounds. High blood pressure is common among most patients. It is especially common among African American men with kidney insufficiency because this population is genetically predisposed to develop high blood pressure.

• Fluid in the lung cavity (pleural effusions) and fluid in the abdomen (ascites) may occur. In rare cases, fluid may build up in the sac that surrounds the heart, a condition called pericardial effusions.

• Glomerulonephritis: In general, symptoms of glomerulonephritis may include dark colored urine, foamy urine (from excess protein in the urine), high blood pressure, fluid retention that causes swelling (edema), fatigue, and less frequent urination.

• Kidney cancer: Most patients with kidney cancer do not experience any symptoms during the early stages of the disease. In the later stages, the most common symptom is blood in the urine (called hematuria). Other symptoms may include back pain (just below the ribs), weight loss, fatigue, and occasional fever.

• Kidney stones: If the kidney stone is small, patients do not experience any symptoms of the condition. The stone may pass in the urine without any pain. However, if the stone is large enough to block the tubes inside the kidney, patients may experience intense pains that come and go. Pain may last anywhere from five to 15 minutes at a time. The pain usually begins in the lower back. As the stone moves from the kidney toward the bladder, the patients may feel pain near the abdomen, groin, or genitals. Additional symptoms may include blood in the urine, cloudy or foul-smelling urine, nausea, vomiting, and constant urge to urinate.

• In some patients, the kidney stone may cause an infection. Symptoms of an infection include fever and chills.

• Nephrotoxicity: Symptoms include increased urination, dark urine, blood in the urine, and frequent urge to urinate.

Complications

• Bone disease: Fanconi syndrome may lead to rickets in children and osteomalacia in adults. Both of these conditions cause the bones to become softer and less dense than normal. Rickets may lead to bone deformities, stunted growth, and difficulty walking in children. Osteomalacia (rickets in adults) may cause severe bone pain and spontaneous bone fractures. Unlike rickets that is caused by poor nutrition, these conditions cannot be reversed with vitamin D supplementation.

• High blood pressure: Some patients with kidney disorders, such as glomerulonephritis, may develop high blood pressure. If the kidneys do not filter the blood properly, the extra fluid and waste in the blood vessels may cause high blood pressure.

• Having high blood pressure may worsen symptoms of kidney disease. This is because high blood pressure damages the blood vessels throughout the body, including the kidneys.

• Kidney failure: Patients with kidney disease, including focal segmental glomerulosclerosis (FSGS), glomerulonephritis, kidney cancer, and nephrotoxicity, may develop kidney failure. When this happens the kidneys are damaged beyond repair. Kidney failure is fatal unless treated with a kidney transplant. Symptoms may include altered mental status and advanced uremia (build up of waste in the blood due to severe kidney disease). Symptoms of uremia include nausea, vomiting, bleeding, and seizures.

Diagnosis

• Blood urea nitrogen (BUN) test: The blood urea nitrogen (BUN) test measures the amount of nitrogenous waste in the patient's blood. If a patient has high levels of waste products in the blood, it indicates that the kidneys are not able to filter the blood. Healthy individuals usually have 7-20 milligrams of waste per deciliter of blood. Elevated levels indicate kidney disease.

• Creatine: A creatine test is used to measure the amount of creatine in a patient's blood or urine. This helps determine how well the kidneys are able to filter small molecules, such as creatine, out of the blood. Healthy individuals usually have about 0.8-1.4 milligrams of creatine per deciliter of blood. Elevated levels indicate kidney disease.

• A healthcare provider then uses the creatine test results, along with the patient's age, weight, and gender, to determine his/her estimated glomerular filtration rate (EGFR). This rate represents how well the kidneys are able to filter the blood over a period of time. Healthy men typically have EGFRs of 97-137 milliliters/minute, while females have rates of about 88-128 milliliters/minute. Lower-than-normal results indicate kidney disease.

• Imaging studies: Imaging studies, such as a computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan, may be performed if cancer or kidney stones are suspected. These tests take pictures of the kidneys, allowing healthcare providers to detect tumors or kidney stones.

• Kidney biopsy: A kidney biopsy is the most definitive diagnostic test for most kidney disorders, including kidney cancer. During the procedure, which is performed at a hospital, a needle is inserted into the kidney and a small tissue sample is removed from either the kidney or a tumor on the kidney. Patients may be awake and receive medication to numb the area near the kidney, or patients may receive general anesthesia so that they are asleep during the procedure. The tissue is then analyzed in a laboratory. Kidney damage is indicated if scar tissue is revealed in the kidney tissue. If cancerous cells are present in the tumor tissue, cancer is diagnosed.

• Patients may have to stay overnight at the hospital. Most patients experience soreness near the biopsy site. Patients should tell their healthcare providers if there is blood in their urine more than 24 hours after the test, if they are unable to urinate, if they have a fever, if they experience increased pain at biopsy site, or if they feel dizzy. In rare cases, an infection may develop.

• Urinalysis (analysis of the urine): A urinalysis, also called a urine sample test, is used to measure the levels of protein in the urine. Elevated levels of protein in the urine (with or without small amounts of blood) suggest kidney disease.

Treatment

• Hemodialysis: In cases of severe kidney damage or kidney failure, hemodialysis may be administered. Dialysis is a method of removing toxic substances and waste from the blood because dysfunctional kidneys are unable to perform this function. During the procedure, a hollow tube, called a catheter, is inserted into a patient's vein at the hospital. The blood is then filtered through a dialysis machine to remove waste products from the blood. The filtered blood is then returned to the patient. This procedure typically lasts about three to four hours. In general, patients with kidney failure undergo dialysis about three times a week.

• Patients who develop nephrotoxicity may also require dialysis in order to remove toxic substances from the body.

• Peritoneal dialysis: Patients who have kidney failure may undergo peritoneal dialysis. This type of dialysis can be performed at home, but it must be done every day.

• During peritoneal dialysis, a catheter fills the abdomen with a dialysis solution, which removes toxins from the blood. The abdominal walls are lined with a membrane called the peritoneum. This membrane allows extra fluid to pass from the blood and into the dialysis solution. The dialysis solution collects the waste, and then the dialysis solution is drained from the body. The entire process takes about 30-40 minutes per day. Most patients have to repeat this process about four times a day.

• A type of peritoneal dialysis called continuous ambulatory peritoneal dialysis (CAPD) does not require a machine. Patients are able to go about their normal daily activities while the dialysis solution is in the abdomen. Another type of peritoneal dialysis, called continuous cycling peritoneal dialysis (CCPD), involves a machine that fills and drains the abdomen, usually while the patient sleeps.

• Diuretics: Diuretics, such as furosemide (Lasix®), have been used to treat edema, which is associated with many types of kidney disorders, including focal segmental glomerulosclerosis (FSGS) and glomerulonephritis. These drugs signal the kidneys to increase urine output. This reduces the amount of fluid in the bloodstream, which subsequently reduces swelling and lowers blood pressure.

• Anti-hypertensives (ACE inhibitors): Anti-hypertensives (drugs that lower blood pressure) have been used to treat high blood pressure. When the kidneys do not filter the blood properly, the pressure in the blood vessels may increase, causing high blood pressure. One type of drug for high blood pressure, called an ACE inhibitor, reduces the amount of protein in the urine by reducing the amount of pressure and resistance on blood as it circulates through the body.

• Extracorporeal shock wave lithotripsy (ESWL): If patients with kidney stones are unable to pass their stones by drinking extra fluids, a procedure called extracorporeal shock wave lithotripsy (ESWL) may be performed. This is the most commonly used procedure to remove kidney stones. Sound waves (shock waves) are used to break the stone into smaller pieces.

• Patients will receive sedatives and/or anesthesia before the procedure. The patient will either be partially submerged in a tub of water or will lie on a soft cushion. Patients wear headphones because the shock waves are loud. High-energy sound waves then pass through the patient's body and break the stone into smaller pieces. The healthcare provider usually uses X-rays or an ultrasound to ensure that the stone breaks down. Treatment usually lasts for about one hour.

• Side effects of treatment include blood in the urine, bruising on the abdomen or back, bleeding around the kidney or nearby organs, and pain when the stone fragments are passed in the urine.

• Transplant: Some patients with kidney disease may develop kidney failure. When this happens, the kidneys are no longer able to function properly. Kidney failure is fatal without a kidney transplant because these organs are vital for daily living. Since individuals can function with just one kidney, only one donated kidney must be transplanted into the patient.

• After the kidney transplant, patients will need to take drugs called immunosuppressants for the rest of their lives in order to prevent their bodies from attacking the transplanted organs. The most commonly prescribed oral immunosuppressants include tacrolimus (Prograf®), mycophenolate mofetil (CellCept®), sirolimus (Rapamune®), prednisone (Prednisone Intensol®), cyclosoporine (Neoral®, Sandimmune®, or Gengraf®), and azathioprine (Imuran®). In general, patients are typically prescribed two to three medications for long-term immunosuppression.

• Also, since kidney transplant recipients have only one functioning kidney after surgery, patients will need to alter their diets so the kidney is not overworked. For instance, alcohol and caffeine should be avoided because these products contain many toxins and wastes that are difficult for just one kidney to filter from the blood.

• Not all kidney failure patients are suitable candidates for kidney transplantation. The transplant must come from a donor whose body tissues are a close biological match to the recipient. The donated kidney may come from a living relative who is a match or from a deceased donor. In order to receive an organ from a deceased donor, patients are added to a national waiting list. Members of the transplant center conduct medical tests and consider the patient's mental and physical health, as well as his/her personal support system before adding him/her to the transplant list. There is no way to know how long a patient will wait. Some patients will wait weeks, while others may wait years. Some patients die of kidney failure before they are able to receive an organ.

• As with any major surgery, serious health risks are associated with the kidney transplantation. Individuals who have weakened immune systems are at risk of developing graft-versus-host disease after surgery. This condition occurs when the transplanted organ attacks the recipient's weakened immune system. Other recipients may experience transplant rejection, which occurs when the body's immune system attacks the donated organ.

• Surgery: Patients with kidney cancer typically have their tumors surgically removed, if possible. If the tumor is very large, the kidney may also need to be removed. Individuals are able to live with just one kidney. However, if both kidneys are removed, the patient must receive a kidney transplantation.

• Radiation therapy: Radiation therapy may be used along with surgery to treat patients with kidney cancer. During the procedure, the patient's kidney is exposed to high-energy beams, which kill cancerous cells. Patients typically receive treatment five days a week for several weeks.

• Side effects may include fatigue, skin rash, nausea, and vomiting.

• Chemotherapy: Chemotherapy, which involves drugs that kill cancerous cells, is generally not used to treat kidney cancer. This is because chemotherapy has not been shown to be an effective treatment for patients with kidney cancer. Other therapies, such as surgery and immunotherapy, have been shown to be more effective treatments.

• Arterial embolization: Patients with kidney cancer may undergo a procedure called arterial embolization. A specialized healthcare professional, called a radiologist, injects a chemical into the main blood vessel that leads to the kidney. This substance clogs the blood vessel, which starves the tumor of nutrients. This procedure is typically used when the tumor cannot be surgically removed. Side effects may include temporary nausea, vomiting, or pain.

• Cryoablation: A procedure, called cryoablation, may be performed if a kidney tumor cannot be removed. During the procedure, one or more specialized needles are inserted into the tumor. The needles contain a gas that causes the tumor to become so cold that it freezes. The needles are removed. Then, needles that contain a different kind of gas are inserted into the tumor. These needles warm the tumor. When the tumor is thawed, the process is repeated. The cycle of freezing and thawing the tumor eventually kills the tumor. Patients may experience pain after cryoablation. Rare side effects include infection, bleeding, and damage to the tissues surrounding the tumor.

• Immunotherapy: Patients with kidney cancer may also receive immunotherapy, which helps the body's immune system fight against cancerous cells in the body. Patients receive injections with interferon and/or interleukin-2, which are normally produced by the body. Immunotherapy is usually administered in combination with surgery. The duration of treatment varies among patients. Medication may be given daily, weekly, or several times a week. Side effects may include nausea, vomiting, decreased appetite, fatigue, and fever. Some patients may bruise easily after treatment.

Integrative Therapies

• Strong scientific evidence:

• Phosphates, phosphorus: Phosphorus is a mineral found in many foods, including milk, cheese, dried beans, peas, nuts, and peanut butter. Phosphorus plays an important role in the formation of bones and teeth. Phosphate is the most common form of phosphorus. Phosphate salts (except for calcium phosphate) have been shown to effectively reduce hypercalcemia (high blood calcium levels). Hypercalcemia may occur as a result of kidney disorders such as Fanconi syndrome. High levels of calcium in the blood may also lead to kidney stones. However, intravenous phosphate may not be recommended as a treatment for hypercalcemia due to concerns about lowering blood pressure, excessively lowering calcium levels, heart attack, tetany, and kidney failure. Sudden low blood pressure, kidney failure, and death have been reported after phosphate infusion.

• The U.S. Food and Drug Administration (FDA) has approved the use of phosphates for the treatment of hypophosphatemia (low blood phosphorus level) in adults. Taking sodium phosphate or potassium phosphate has been shown to effectively prevent and treat most causes of hypophosphatemia. Patients should only take phosphate supplements under the guidance of their healthcare providers. The underlying cause of the hypophosphatemia should be identified and corrected whenever possible.

• Kidney stones (nephrolithiasis) are an U.S. Food and Drug Administration (FDA)-labeled use of phosphates in adults. Taking potassium and sodium phosphate salts orally may help prevent kidney stones in patients with hypercalciuria (high urine calcium levels) and in patients with kidney stones made of calcium oxalate. However, phosphate administration when stones are composed of magnesium-ammonium-phosphate or calcium phosphate may increase the rate of stone formation.

• Avoid if allergic or hypersensitive to any ingredients in phosphorus/phosphate preparations. Use phosphorus/phosphate salts cautiously with kidney or liver disease, heart failure, chest pain (angina), recent heart surgery, hyperphosphatemia (high phosphate blood level), hypocalcemia (low calcium blood level), hypokalemia (low potassium blood level), hypernatremia (high sodium blood level), Addison's disease, intestinal obstruction or ileus, bowel perforation, severe chronic constipation, acute colitis, toxic megacolon, hypomotility syndrome, hypothyroidism, scleroderma, or gastric retention. Avoid sodium phosphate enemas with congenital (present at birth) abnormalities of the intestine. Too much phosphorus may cause serious or life-threatening toxicity.

• Vitamin D: Vitamin D is found in many foods, including fish, eggs, fortified milk, and cod liver oil. The sun also helps the body produce vitamin D. Fanconi syndrome is a defect of the proximal tubules of the kidney that is associated with kidney tubular acidosis. Taking vitamin D by mouth has been shown to effectively treat Fanconi syndrome-related hypophosphatemia.

• Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses. Doses higher than recommended may cause toxic effects. Individuals with overactive thyroid glands, kidney disease, sarcoidosis, tuberculosis, or histoplasmosis have an increased risk of experiencing toxic effects. Vitamin D is generally considered safe for pregnant women. It may be necessary to give infants vitamin D supplements along with breast milk in order to prevent vitamin D deficiency.

• Good scientific evidence:

• Chelation therapy: During chelation therapy, EDTA (ethylenediamine tetraacetic acid), usually in combination with vitamins, trace elements, and iron supplements, is injected into the vein to treat a variety of diseases. Several studies support the use of EDTA chelation to reduce lead toxicity associated with chronic kidney insufficiency and to slow the progression of the disorder. More studies are needed to confirm these findings, but EDTA chelation may be considered a useful adjunctive therapy for the treatment of kidney dysfunction.

• Avoid with heart disease, liver disease, kidney disease, immune system disorders, bleeding disorders, or if taking drugs that increase the risk of bleeding. Avoid if pregnant or breastfeeding due to potential toxic effects.

• Rhubarb: In laboratory studies, rhubarb has been shown to have positive effects on chronic kidney failure. These studies show promise for human use. In some studies, rhubarb is more effective than captopril, and rhubarb combined with captopril is more effective than either substance alone. Higher quality studies are necessary to confirm this hypothesis.

• Avoid if allergic or hypersensitive to rhubarb, its constituents, or related plants from the Polygonaceae family. Avoid using rhubarb for more than two weeks because it may induce tolerance in the colon, melanosis coli, laxative dependence, pathological alterations to the colonic smooth muscles, and substantial loss of electrolytes. Avoid with atony, colitis, Crohn's disease, dehydration with electrolyte depletion, diarrhea, hemorrhoids, insufficient liver function, intestinal obstruction or ileus, irritable bowel syndrome, menstruation, pre-eclampsia, kidney disorders, ulcerative colitis, or urinary problems. Avoid handling rhubarb leaves, as they may cause contact dermatitis. Avoid rhubarb in children younger than 12 years old. Use cautiously with bleeding disorders, cardiac conditions, or constipation. Use cautiously with a history of kidney stones or thin or brittle bones. Use cautiously if taking anti-psychotic drugs, anticoagulants, or oral drugs, herbs, or supplements (including calcium, iron, and zinc) with similar effects. Avoid if pregnant or breastfeeding.

• Unclear or conflicting scientific evidence:

• Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called "chi," circulates. These pathways contain specific "points" that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. Illness and symptoms are thought to be caused by problems in the circulation of chi through the meridians. There has been limited research on acupuncture for the treatment of kidney disorders, such as gouty kidney damage. At this time, there is inadequate available evidence to recommend for or against the use of acupuncture for these indications. More research is needed.

• Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, and neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Avoid if taking anticoagulants. Use cautiously with respiratory disease (e.g. asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with a history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.

• Alpha-lipoic acid: Alpha-lipoic acid (ALA) may provide some benefit in kidney disease, but there is not enough evidence to make a conclusion.

• Avoid if allergic to ALA. Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.

• Arabinogalactan: Although early results of arabinogalactan's effect in patients with chronic kidney failure are promising, more studies are needed.

• Avoid if allergic or sensitive to arabinogalactan or larch. People who are exposed to arabinogalactan or larch dust may have irritation of the eyes, lungs, or skin. Use cautiously in people with diabetes, digestive problems, or immune system disorders, and in people who consume a diet that is high in fiber or low in galactose. Arabinogalactan should not be used during pregnancy or breastfeeding.

• Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required. Study results are mixed as to whether arginine as a therapy by itself directly helps with certain kidney diseases or kidney failure. Arginine may be a helpful adjunct for kidney disease related conditions such as anemia in the elderly. Additional research is needed in this area.

• Avoid if allergic to arginine, or with a history of stroke, or liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.

• Astragalus: In traditional Chinese medicine (TCM), astragalus is commonly found in mixtures with other herbs. Western herbalists began using astragalus in the 1800s as an ingredient in various tonics. Several animal and human studies report that kidney damage from toxins and kidney failure may be improved with the use of astragalus-containing herbal mixtures. Overall, this research has been poorly designed and reported. Astragalus alone has not been well evaluated. Better quality research is necessary before a conclusion can be made.

• Avoid if allergic to astragalus, peas, or any related plants. Avoid with a history of Quillaja bark-induced asthma. Avoid if taking aspirin, aspirin products, or herbs or supplements with similar effects. Avoid with inflammation, fever, stroke, transplant, or autoimmune diseases. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously if taking blood-thinners, blood sugar drugs, diuretics, or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.

• Chitosan: Limited evidence suggests that chitosan may be useful during long-term hemodialysis for patients with kidney failure. Further studies are needed to determine safety and efficacy.

• Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.

• Coenzyme Q10: Coenzyme Q10 (CoQ10), which is produced by the human body, is needed for the basic functioning of cells. Early research supports the use of CoQ10 supplements for the treatment of kidney failure. However, more research is needed before a firm conclusion can be made.

• Reports on allergic reactions to CoQ10 supplements are lacking. However, there have been reports of rare cases of rash and itching after CoQ10 use. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures that have bleeding risks. Use cautiously with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke. Use cautiously if taking anticoagulants (blood thinners), anti-platelet drugs (e.g. aspirin, warfarin, or clopidogrel), blood pressure drugs, blood sugar drugs, cholesterol drugs, or thyroid drugs. Avoid if pregnant or breastfeeding.

• Color therapy: Early research found that light-color stimulation improved cardiovascular symptoms in patients with glomerular nephritis (inflammation of the kidney). More research is needed in this area.

• Color therapy is generally considered safe. Exposure to bright light may cause eye injury, such as retinopathy. Strobe lights may cause seizures in susceptible individuals. Use cautiously during pregnancy or breastfeeding.

• Cordyceps: Cordyceps is a parasitic fungi that has been used as a tonic food in China and Tibet. In traditional Chinese medicine (TCM), cordyceps is used to strengthen kidney function. Studies indicate that cordyceps may improve kidney function in patients with chronic kidney failure or drug-induced nephrotoxicity. Early study results are promising, however, additional research is needed.

• Avoid if allergic or hypersensitive to cordyceps, mold, or fungi. Use cautiously with diabetes, bleeding disorders, or prostate conditions. Use cautiously if taking immunosuppressants, anticoagulants, hormonal replacement therapy, or birth control pills. Avoid with myelogenous type cancers. Avoid if pregnant or breastfeeding.

• Cornflower: Cornflower flowers may be helpful in preventing the recurrence of urinary tract stones. However, more studies are needed to confirm early study results.

• Avoid if allergic or hypersensitive to cornflower (Centaurea cyanus), its constituents, or members of the Asteraceae/Compositae family, such as dandelion, goldenrod, ragweed, sunflower, and daisies. Use cautiously if taking anti-inflammatory agents or if in treatment for urinary tract stones. Avoid if pregnant or breastfeeding.

• Cranberry: Cranberries come from small evergreen shrubs with tart, red, edible berries. The berries are used in sauces, jellies, and drinks. Based on preliminary research, it is not clear if drinking cranberry juice increases or decreases the risk of urinary tract stones. Cranberry juice is reported to decrease urine levels of calcium, increase levels of urine magnesium and potassium, and increase urine levels of oxalate.

• Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Avoid more than the amount usually found in foods if pregnant or breastfeeding.

• Creatine: Creatine is an amino acid that is found in the muscles. Limited available study suggests that creatine does not lower homocysteine levels in hemodialysis patients. However, these patients were also taking vitamin B12 and folate. Therefore, a firm conclusion cannot be made until further research is performed.

• Avoid if allergic or hypersensitive to creatine. Early research suggests that creatine may reduce muscle cramps that are often associated with hemodialysis. However, further studies are needed to confirm this claim.

• Avoid if taking diuretics (e.g. hydrochlorothiazide or furosemide). Use cautiously with asthma, diabetes, gout, kidney disease, liver disease, muscle problems, stroke, or with a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.

• Danshen: Danshen (Salvia miltiorrhiza) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. Although early evidence is promising, it is unknown whether danshen is a safe and effective treatment for kidney disease. Early studies suggest that danshen may speed dialysis and ultrafiltration rates when added to dialysate solution. Although this evidence seems promising, it is not known whether danshen is safe for this use.

• Avoid if allergic or hypersensitive to danshen. Avoid if taking blood thinners (anticoagulants), digoxin, or hypotensive agents. Avoid with bleeding disorders, low blood pressure, and following cerebral ischemia (inadequate blood flow to the brain). Use cautiously if taking sedatives, hypolipidemics (blood pressure-lowering medications), cardiac glycosides, CYP-metabolized agents, nitrate ester, steroidal agents, or some anti-inflammatories (such as ibuprofen). Use cautiously with altered immune states, arrhythmia (irregular heartbeat), compromised liver function, or with a history of glaucoma, stroke, or ulcers. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures that have bleeding risks. Use cautiously if driving or operating heavy machinery. Avoid if pregnant or breastfeeding.

• Dong quai: Dong quai (Angelica sinensis), also known as Chinese angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. It remains one of the most popular plants in Chinese medicine, and it is most commonly used for health conditions in women. There is insufficient evidence to support the use of Dong quai as a treatment for kidney diseases, such as glomerulonephritis. Preliminary, poor-quality research of Dong quai in combination with other herbs has reported unclear results.

• Although Dong quai is accepted as being safe as a food additive in the United States and Europe, it remains unknown if it is in larger doses as a medical treatment. There are no reliable long-term studies of side effects available. Avoid if allergic or hypersensitive to Angelic radix or members of the Aplaceael Umbelliferae family (e.g. anise, caraway, carrot, celery, dill, or parsley). Avoid prolonged exposure to sunlight or ultraviolet light. Use cautiously with bleeding disorders, diabetes, glucose intolerance, or hormone sensitive conditions (e.g. breast cancer, uterine cancer, or ovarian cancer). Use cautiously if taking blood thinners. Do not use immediately before or two weeks after dental or surgical procedures that have bleeding risks. Avoid if pregnant or breastfeeding.

• Flaxseed: Flaxseed is a rich source of the essential fatty acid, alpha-linolenic acid (omega-6). Alpha-linolenic acid is a building block in the body for omega-3 fatty acids. Flaxseed (not flaxseed oil) may help treat kidney diseases, such as lupus nephritis. However, further research is needed before a firm conclusion can be made.

• Flaxseed has been well-tolerated in studies for up to four months. Avoid if allergic to flaxseed, flaxseed oil, or other plants of the Linaceae family. Avoid with prostate cancer, breast cancer, uterine cancer, or endometriosis. Avoid ingestion of immature flaxseed pods. Avoid large amounts of flaxseed by mouth. Mix flaxseed with plenty of water or liquid before ingesting. Avoid flaxseed (not flaxseed oil) with a history of esophageal stricture, ileus, gastrointestinal stricture, or bowel obstruction. Avoid with a history of acute or chronic diarrhea, irritable bowel syndrome, diverticulitis, or inflammatory bowel disease. Avoid topical flaxseed in open wounds or abraded skin surfaces. Use cautiously with a history of bleeding disorders, high triglyceride levels, diabetes, mania, seizures, or asthma. Use cautiously if taking blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs). Avoid if pregnant or breastfeeding.

• Ginseng: Asian ginseng, or Panax ginseng, has been used for more than 2,000 years in Chinese medicine for various health conditions. There is preliminary evidence of a beneficial effect of Panax notoginseng in diabetic nephropathy. Additional studies are warranted.For kidney dysfunction, a combination of herbs that included ginseng was not better than treatment with a conventional medicine plus traditional Chinese medicine. More research is needed because the effects of ginseng alone are unknown.

• Avoid ginseng with a known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.

• Grapefruit: There is limited and mixed research regarding the use of grapefruit for kidney stones. Further research is needed to clarify these results.

• Avoid if allergic/hypersensitive to grapefruit or its constituents. Use cautiously if taking cytochrome P450 3A4 substrates, such as blood thinners, heart medications, anticonvulsants, antidepressants, antihistamines, blood pressure medications, benzodiazepines, calcium channel blockers, caffeine, corticosteroids, diabetes medications, erectile dysfunction medications, estrogens, immune modulators, HMG-CoA reductase inhibitors, macrolide antibiotics, or protease inhibitors. Use cautiously if drinking red wine, tonic water, or if smoking. Use cautiously with liver cirrhosis, if at risk for kidney stones, if have undergone gastric bypass surgery, and with diabetes. Use cautiously if pregnant or breastfeeding. Blood pressure changes, enamel loss, headaches, hives, increased potassium clearance, increased or decreased development of kidney stones, inhibited intestinal CYP3A4-mediated first-pass metabolism, itching, lowered elevated hematocrits, pseudohyperaldosteronism (Liddle's syndrome), and tooth surface loss have been reported.

• Hyssop: Preliminary study using combination therapy with a decoction (a preparation made by boiling a plant in water) of qingre huoxue recipe (QHR), which contains less than 10% of giant-hyssop herb, may improve kidney function in patients with mid-advanced crescentic nephritis (kidney inflammation). Higher quality studies using hyssop alone are needed to further evaluate hyssop's effect on nephritis.

• Avoid if allergic/hypersensitive to hyssop, any of its constituents, or any related plants in the Lamiaceae family. Use cautiously with diabetes or if taking antivirals or immunosuppressants. Avoid with seizure disorders, fever, high blood pressure, or if taking medications that affect seizure threshold. Avoid in children. Avoid sustained use of hyssop oil (10 to 30 drops daily for adults). Avoid if pregnant or breastfeeding.

• L-carnitine: L-carnitine is an amino acid that is made in the liver and muscles. Although preliminary evidence is promising, there is insufficient available evidence to recommend for or against the use of carnitine for dialysis patients. More research is needed.

• Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.

• Lycopene: Lycopene is a carotenoid found in tomatoes, and it is also present in human serum, liver, adrenal glands, lungs, prostate, colon, and skin. There is very limited evidence that lycopene supplements may not reduce the risk of renal cell cancer. Additional research is needed.

• Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive data, avoid if pregnant or breastfeeding.

• Omega-3 fatty acids: Omega-3 fatty acids are found in fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Studies investigating the effect of omega-3 fatty acids on patients with immunoglobulin A (IgA) nephropathy have produced conflicting results. Further research is warranted in this area. Additional research is also needed to determine whether or not omega-3 fatty acids can effectively treat nephrotic syndrome in general.

• Avoid if allergic or hypersensitive to products that contain omega-3 fatty acid, omega-6 fatty acid, or linolenic acid. This includes some fish and nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure, or if taking drugs, or herbs, or supplements that treat any such conditions. Use cautiously before surgery. Omega-3 fatty acids are considered safe in pregnancy and breastfeeding when taken in the recommended doses.

• Peony: Human studies suggest that patients with a type of kidney disease called crescentic nephritis may need less glucocorticoid medication with use of peony. More research is needed to support this use.

• Avoid if allergic or sensitive to peony. Avoid with bleeding disorders or if taking drugs, herbs, or supplements that increase bleeding risk. Use cautiously with estrogen-sensitive cancers or if taking drugs, herbs, or supplements with hormonal activity. Avoid if pregnant or breastfeeding.

• Phosphates, phosphorus: Long term, slow release neutral potassium phosphate has been shown to reduce calcium excretion in subjects with absorptive hypercalciuria (high urine calcium levels) and appears to be well tolerated. This use of phosphates may be considered to prevent kidney stone formation.

• Avoid if allergic or hypersensitive to any ingredients in phosphorus/phosphate preparations. Use phosphorus/phosphate salts cautiously with kidney or liver disease, heart failure, chest pain (angina), recent heart surgery, hyperphosphatemia (high phosphate blood level), hypocalcemia (low calcium blood level), hypokalemia (low potassium blood level), hypernatremia (high sodium blood level), Addison's disease, intestinal obstruction or ileus, bowel perforation, severe chronic constipation, acute colitis, toxic megacolon, hypomotility syndrome, hypothyroidism, scleroderma, or gastric retention. Avoid sodium phosphate enemas with congenital (present at birth) abnormalities of the intestine. Too much phosphorus may cause serious or life-threatening toxicity.

• Prayer, distant healing: Prayer can be defined as a "reverent petition," the act of asking for something while aiming to connect with God or another object of worship. Prayer on behalf of the ill or dying has played a prominent role throughout history and across cultures. Metaphysical explanations and beliefs often underlie the practice of prayer. Preliminary research shows positive trends associated with prayer and spirituality in patients with end stage kidney disease who are coping after a kidney transplant. Further research is needed before conclusions can be drawn.

• Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches and require an open dialog between patients and caregivers.

• Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient explores thoughts, feelings, and behaviors to help with problem solving. Although individual and group psychotherapy may decrease depression associated with a kidney transplant, individual therapy may be more effective than group therapy. More research is needed in this area.

• Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases, symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expressions.

• Reishi mushroom: Reishi mushroom (Ganoderma lucidum), also known as Ling Zhi in China, grows wild on decaying logs and tree stumps. Reishi grows in six different colors. The red-colored mushroom is most commonly used and grown in East Asia and North America. Limited available study investigated reishi mushroom for the treatment of proteinuria in patients with kidney disorders. Further research is needed in order to make a firm conclusion.

• Avoid if allergic or hypersensitive to reishi mushroom, any of its constituents, or any members of its family. Use cautiously with diabetes, blood disorders (including hemophilia), low blood pressure, or ulcers. Avoid if pregnant or breastfeeding.

• Rhubarb: In traditional Chinese medicine (TCM), rhubarb is used as an ulcer remedy, and it is considered a bitter, cold, dry herb used to "clear heat" from the liver, stomach, and blood. Preliminary study using a combination therapy with a decoction of qingre huoxue recipe (QHR), which contains less than 10% of rhubarb, may improve kidney function in patients with mid-advanced crescentic nephritis. Higher quality studies using rhubarb as a monotherapy are needed to evaluate rhubarb's effect on nephritis.

• Avoid if allergic or hypersensitive to rhubarb, its constituents, or related plants from the Polygonaceae family. Avoid using rhubarb for more than two weeks because it may induce tolerance in the colon, melanosis coli, laxative dependence, pathological alterations to the colonic smooth muscles, and substantial loss of electrolytes. Avoid with atony, colitis, Crohn's disease, dehydration with electrolyte depletion, diarrhea, hemorrhoids, insufficient liver function, intestinal obstruction or ileus, irritable bowel syndrome, menstruation, pre-eclampsia, kidney disorders, ulcerative colitis, and urinary problems. Avoid handling rhubarb leaves, as they may cause contact dermatitis. Avoid rhubarb in children younger than 12 years old. Use cautiously with bleeding disorders, cardiac conditions, constipation, or with a history of kidney stones or thin or brittle bones. Use cautiously if taking anti-psychotic drugs, blood thinners, or oral drugs, herbs, or supplements (including calcium, iron, and zinc). Avoid if pregnant or breastfeeding.

• Safflower: Safflower oil is ingested as a food or supplement, infused intravenously, or applied topically. There is currently insufficient available evidence to recommend for or against the use of safflower in the treatment of type II nephritic syndrome.

• Avoid if allergic or hypersensitive to safflower (Carthamus tinctorius), safflower oil, daisies, ragweed, chrysanthemums, marigolds, or any related constituents. Use parenteral safflower oil emulsions cautiously in newborns. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, immunosuppressants, or pentobarbital. Use cautiously with diabetes, low blood pressure, inadequate liver function, bleeding disorders, or skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.

• Selenium: Selenium is a mineral found in soil, water, and some foods. The benefits of selenium supplementation in dialysis patients remain unclear. Some methods of dialysis may lower plasma selenium levels.

• Avoid if allergic or sensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.

• Soy: Due to limited human study, there is not enough evidence to recommend for or against the use of soy in the treatment of kidney diseases, such as chronic renal failure, nephrotic syndrome, and proteinuria. Patients with kidney disease should speak to their healthcare providers about recommended amounts of dietary protein, as soy is a high protein food.

• Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there are limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore, are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is unknown if soy or soy isoflavones share the same side effects as estrogens (e.g. increased risk of blood clots). The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or prostate cancer. Other hormone-sensitive conditions, such as endometriosis, may also be worsened. Patients taking blood-thinning drugs (e.g. warfarin) should check with their doctors and/or pharmacists before taking soy supplementation.

• Traditional Chinese medicine (TCM): Traditional Chinese medicine (TCM) herbs have been reported to improve the therapeutic effectiveness and to counteract adverse reactions to hormone therapy in treatment of nephrotic syndrome and to reduce the recurrence of symptoms. TCM herbs may also augment conventional medicine in treatment of diabetic nephropathy. More studies of better design are needed before recommendations can be made.

• Chinese herbs can be potent and may interact with other herbs, foods, or drugs. Consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ephedra (ma huang). Avoid ginseng if pregnant or breastfeeding.

• Vitamin B6: Pyridoxine alone, or taken with magnesium, may decrease urinary oxalate levels, which may contribute to formation of kidney stones. Higher pyridoxine intake has been associated with decreased risk of kidney stone formation in women but not in men with no history of stone formation. Benefit has not been proven in some types of kidney stones such as those associated with high urinary calcium, phosphorus, and creatinine. Further data is needed before a firm conclusion can be drawn.

• Some individuals may be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA).

• Vitamin E: Vitamin E exists in eight different forms (called isomers): alpha, beta, gamma, and delta tocopherol; and alpha, beta, gamma, and delta tocotrienol. Alpha-tocopherol is the most active form in humans. It has been suggested that proteinuria (protein in the urine) may be reduced with the use of vitamin E in patients with focal segmental glomerulosclerosis, which is refractory to standard medical management. However, further research is necessary before a clear conclusion can be drawn.

• Avoid if allergic or hypersensitive to vitamin E. For short periods of time, vitamin E supplementation is generally considered safe at doses up to 1,000 milligrams per day. Avoid doses higher than 1,000 milligrams a day. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders. The recommended dose of vitamin E for pregnant women of any age is 15 milligrams and for breastfeeding women of any age is 19 milligrams. Use beyond this level in pregnant women is not recommended.

• Zinc: Preliminary research suggests that zinc may improve uremia in patients with kidney disorders. Further research is needed to confirm the effectiveness of zinc for kidney function. Zinc supplementation may be recommended only in patients with proven zinc deficiency, whereas its use for all chronic renal failure patients is questionable.

• Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.

• Fair negative scientific evidence:

• Arginine: Animal studies report that arginine blocks the toxic effects of cyclosporine, a drug used to prevent organ transplant rejection. However, results from studies in humans have not found that arginine offers any protection from cyclosporine toxicity.

• The contrast media or dye used during angiography to map a patient's arteries (or during some CT scans) can be toxic to the kidneys, especially to people with pre-existing kidney disease. Clinical study has examined the use of L-arginine for kidney protection during angiography in patients with chronic renal failure. Researchers found no evidence that injections of L-arginine protect the kidney from damage due to contrast. Other therapies, such as N-acetylcysteine (NAC), have been found beneficial at protecting the kidneys from contrast-induced damage, particularly in patients at high-risk (e.g. diabetics).

• Avoid if allergic to arginine, or with a history of stroke, or liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.

• Iodine: Iodine has been suggested as a possible treatment for kidney cysts. However, early research suggests that povidone iodine injections after drainage of kidney cysts are not effective.

• There have been reports of severe and even fatal reactions to iodine. Avoid iodine-based products if allergic to iodine. Do not use for more than 14 days. Avoid lugol solution and the saturated solution of potassium iodide (SSKI, PIMA) with high amounts of potassium in the blood, fluid in the lungs, bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate or burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction.

• Iridology: Iridology is the study of the iris for diagnostic purposes. Iridology assumes that all bodily organs are represented on the surface of the iris via intricate neural connections. Preliminary study submitted photographs of irises of kidney disease patients to practicing iridologists and found no evidence of accurate detection of kidney disease. Therefore, at this time, evidence supporting the use of iridology for kidney disease diagnosis is currently lacking.

• Iridology should not be used alone to diagnose disease. Studies of iridology have reported incorrect diagnoses, and potentially severe medical problems may thus go undiagnosed. In addition, research suggests that iridology may lead to inappropriate treatment.

• Trigger point therapy: Trigger point therapy is used by many healthcare practitioners, including medical doctors, osteopaths, chiropractors, and massage therapists, to relieve pain and dysfunction while re-educating the muscles into pain-free habits. The goal of trigger point therapy for renal colic is to eliminate the trigger points associated with renal colic, and thus lessen the pain. Limited available study demonstrated that trigger point therapy with licodaine may effectively treat renal colic. The results of this study warrant future investigations with more stringent study guidelines.

• Use cautiously with local or systemic infection, anticoagulation or bleeding disorders, or acute muscle trauma. Avoid aspirin ingestion within three days of injection. Avoid with extreme fear of needles, large bruises, phlebitis, varicose veins, undiagnosed lumps, or open wounds. Avoid if allergic to anesthetic agents (mainly caused by aminoester agents).

• Zinc: In a well-designed trial, zinc supplementation did not improve the nutritional status in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

• Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.

Prevention

• Patients should use medications that are known to cause kidney damage, such as the immunosuppressant cyclosporine (Neoral® or Sandimmune®), the anti-HIV drug tenofovir (Viread®), and the antibiotic gentamicin (Geramycin®), cautiously.

• Patients should avoid or minimize exposure to heavy metals and other toxins because it may lead to kidney disorders.

• Patients should drink plenty of water to reduce the risk of developing kidney stones.

• Patients who are diagnosed with kidney disease should visit their healthcare providers regularly and take their medications exactly as prescribed. This will help reduce the patient's risk of developing complications, including kidney failure.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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6. National Kidney Foundation. www.kidney.org.

7. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). http://kidney.niddk.nih.gov.

8. Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com.

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