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HIV-associated nephropathy (HIVAN)

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Related Terms
  • Acquired immune deficiency syndrome, acquired immunodeficiency syndrome, AIDS, antiretroviral therapy, antiretrovirals, ART, blood urea nitrogen test, BUN test, creatine test, dialysis, EGFR, end-stage renal disease, ESRD, estimated glomerular filtration rate, focal segmental glomerulosclerosis, HAART, highly active antiretroviral therapy, HIV, human immunodeficiency virus, immune, immune defense system, immune deficiency, immune reaction, immune response, immune system, immunocompromised, immunodeficiency, kidney, kidney biopsy, kidney damage, kidney disease, kidney failure, kidney transplant, nephropathy, protease inhibitor, renal damage, renal disease, renal failure, viral infection, virus, weakened immune system, white blood cells.

Background
  • HIV-associated nephropathy (HIVAN) is a type of kidney disease that occurs in patients who are infected with the human immunodeficiency virus (HIV). HIVAN is characterized by high levels of protein in the urine, high levels of nitrogenous (waste) products in the blood, and scarring or hardening of blood vessels in the kidneys (focal segmental glomerulosclerosis). Patients with HIVAN often suffer from symptoms such as increased urination, excessive thirst, and fatigue.
  • The kidneys, which are a pair of organs located on the left and right side of the abdomen, are an essential component of the urinary tract. They remove toxins, chemicals, and waste products from the blood. They also regulate acid concentration and maintain water and electrolyte balance in the body by excreting urine.
  • HIVAN occurs when the HIV virus infects cells inside the kidneys or the medications used to treat HIV damage kidney cells. When the cells become damaged, the kidneys do not function properly and symptoms of HIVAN develop.
  • Prognosis of HIVAN patients varies. If the condition is left untreated, it can lead to kidney failure and possibly death. According to the U.S. Renal Data System (USRDS), HIVAN accounts for about one percent of new end-stage renal disease (ESRD, also called kidney failure) cases in the United States. HIVAN is the third leading cause of ESRD among African Americans ages 20-64 years old. An estimated 90% of HIVAN patients are African American. It is unknown exactly why African Americans are predisposed to kidney disease. About half of African Americans with HIVAN are injection drug users. It is believed that injection drug use damages the kidneys, making drug addicts more vulnerable to developing kidney disease.
  • However, if diagnosed and treated early, HIVAN is curable. If HIV is infecting kidney cells and causing damage, patients receive a combination of anti-HIV drugs, called highly active antiretroviral therapy (HAART). This suppresses the viruses and, in most cases, kidney damage is reversed. If HIV medications are responsible for the kidney damage, a healthcare provider may recommend alternative drugs or doses.

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

Bibliography
  1. AIDSmap.com. . Accessed May 24, 2009.
  2. Bologna RM. HIV-associated nephropathy: clinical characteristics and therapeutic options. AIDS Read. 1999 Jan-Feb;9(1):38-42. .
  3. Gitman MD, Hirschwerk D, Baskin CH, et al. Tenofovir-induced kidney injury. Expert Opin Drug Saf. 2007 Mar;6(2):155-64. .
  4. Fine DM. Renal disease and toxicities: issues for HIV care providers. Top HIV Med. 2006 Dec-2007 Jan;14(5):164-9. .
  5. Infectious Diseases Society of America. . Accessed May 24, 2009.
  6. Karras A, Lafaurie M, Furco A, et al. Tenofovir-related nephrotoxicity in human immunodeficiency virus-infected patients: three cases of renal failure, Fanconi syndrome, and nephrogenic diabetes insipidus. Clin Infect Dis. 2003 Apr 15;36(8):1070-3. Epub 2003 Apr 4. .
  7. Kidney & Urology Foundation of America. . Accessed May 24, 2009.
  8. Miguez-Burbano MJ, Rodriguez A, Hadrigan S, et al. Renal disease in HIV infected subjects: The deleterious effect of smoking. Int Conf AIDS. 2004 Jul 11-16; 15: abstract no. MoPeB3274.
  9. National Kidney Foundation. . Accessed May 24, 2009.
  10. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 24, 2009.
  11. Scialla JJ, Atta MG, Fine DM. Relapse of HIV-associated nephropathy after discontinuing highly active antiretroviral therapy. AIDS. 2007 Jan 11;21(2):263-4. .

Causes
  • HIV may infect cells inside the kidneys and cause organ damage. When the kidneys are damaged, they do not function as well, and symptoms of HIV-associated nephropathy (HIVAN) develop.
  • Antiretrovirals (anti-HIV drugs) may cause kidney damage in HIV patients. Certain classes of antiretrovirals, including nucleoside reverse transcriptase inhibitors like tenofovir (Viread®) and a protease inhibitor called indinavir (Crixivan®), have been shown to cause kidney damage in HIV patients. Patients taking these drugs should undergo blood and urine tests each year to evaluate kidney function.

Symptoms
  • Symptoms of HIV-associated nephropathy (HIVAN) often include fatigue, dehydration, increased urination, excessive thirst, high blood pressure, and rapid heartbeat. Patients who experience such symptoms should consult their healthcare providers.

Diagnosis
  • General: The Infectious Diseases Society of America recommends screening for kidney disease with a urinalysis, creatine test, and/or blood urea nitrogen (BUN) test when HIV is diagnosed. If laboratory tests suggest kidney damage, a kidney biopsy is conducted to confirm a diagnosis of HIV-associated nephropathy (HIVAN).
  • 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 may 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 like creatine out of the blood. Healthy individuals usually have about 0.8-1.4 milligrams of creatine per deciliter of blood. Elevated levels may 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 may indicate kidney disease.
  • Kidney biopsy: A kidney biopsy is the most definitive diagnostic test for HIVAN. During the procedure, which is performed at a hospital, a needle is inserted into the kidney and a small tissue sample is removed. Patients may be awake and receive medication to numb the area near the kidney or patients may be given general anesthesia so that they are asleep during the procedure. The tissue is then analyzed in a laboratory. A positive test will reveal scar tissue, which indicates HIVAN.
  • 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
  • General: Treatment generally involves aggressive highly active antiretroviral therapy (HAART), which suppresses HIV and has been shown to improve kidney function. Corticosteroids may also be used to improve kidney function. Kidney dialysis and/or transplantation may be necessary in cases of severe damage. If the patient is taking antiretrovirals known to cause kidney damage, a healthcare provider may recommend altering the medication or dose.
  • Altering HIV treatment: If the patient is taking antiretrovirals known to cause kidney damage, a healthcare provider may recommend altering the medication or dose.
  • Corticosteroids: Corticosteroids like prednisone (Deltasone®, Orasone®, or Meticorten®) may significantly improve kidney function in some patients with HIVAN. Patients typically receive daily doses of corticosteroids for two to 11 weeks. In order to avoid symptoms of withdrawal, patients should not suddenly stop treatment without talking to their healthcare providers. Instead, patients should slowly taper off the medication under the supervision of their healthcare providers.
  • Highly active antiretroviral therapy (HAART): Highly active antiretroviral therapy (HAART) is a combination of anti-HIV drugs (antiretrovirals) that helps suppress the virus in the body. HAART therapy has been shown to slow the progression of kidney disease in HIVAN patients.
  • Patients receive a combination of drugs from at least two of the four major classes. The four major classes are: fusion inhibitors, protease inhibitors, nucleoside reverse transcriptase inhibitors (NRTIs), and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Each class of drugs interferes with a different stage of HIV's replication process.
  • Most HIV medications are well tolerated, even if the patient has kidney disease. However, patients may need to receive alternative doses of some antiretrovirals, especially non-nucleoside reverse transcriptase inhibitors and protease inhibitors.
  • Kidney dialysis: In cases of severe kidney damage or kidney failure, dialysis 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.
  • Kidney transplant: Some patients with HIVAN may develop kidney failure. When this happens, the kidneys, which are vital for daily living, are no longer able to function properly. Kidney failure is fatal without a kidney transplant. Since individuals can function with just one kidney, only one 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, they 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.
  • However, 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. There is no way to know how long a patient will wait. Some will wait weeks, while others may wait years. It is estimated that 18 people on the organ transplant waiting list die each day.
  • Until recently, people who had HIV were not considered suitable candidates for organ transplantations. Many patients were denied transplants under the assumption that they had shorter life expectancies and less favorable survival rates than other patients in need of transplants. However, now that patients are living longer lives, many groups are reconsidering whether HIV patients should be transplant candidates. Although the United Network for Organ Sharing (UNOS) does not consider HIV infection a contraindication for organ transplantation, the decision to perform transplantation in an HIV-positive individual varies according to policies at individual centers. Some centers will not provide organ transplants to good candidates who are HIV-positive.
  • 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.

Integrative therapies
  • Note: Patients should consult their healthcare providers before beginning integrative treatments, especially if they recently received a kidney transplant. Although chelation therapy may improve kidney function, it should be avoided in HIV patients because it may further weaken the patient's immune system.
  • 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. However, although chelation therapy may improve kidney function, it should be avoided in HIV patients because it may further weaken the patient's immune system.
  • 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. 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.
  • 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.
  • 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. 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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 or nephrotic syndrome. 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. 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 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:
  • 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.

Prevention
  • Since HIV may infect kidney cells and lead to kidney disease, patients should receive treatment with highly active antiretroviral therapy (HAART). This therapy involves combinations of different anti-HIV drugs (called antiretrovirals). HAART suppresses HIV, which boosts the immune system and reduces the risk of HIV-associated nephropathy (HIVAN).
  • Certain classes of antiretrovirals, including nucleoside reverse transcriptase inhibitors like tenofovir (Viread®) and a protease inhibitor called indinavir (Crixivan®), should be used cautiously in patients with a history of kidney disease because they have shown to cause kidney damage.
  • Kidney transplant recipients will need to alter their diets so they do not overwork their new kidney. 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.

Complications
  • HIV-associated nephropathy (HIVAN) may lead to end-stage renal (kidney) disease (ESRD), also called kidney failure. This occurs when the kidneys are no longer able to perform functions necessary for daily living. The kidneys can no longer remove toxins and waste products from the blood, regulate acid concentration, or maintain water and electrolyte balance in the body. ESRD is fatal, unless treated with dialysis or kidney transplantation.
  • Common symptoms of ESRD include unintentional weight loss, nausea or vomiting, general feeing of discomfort, fatigue, decreased urination, generalized itching, easy bruising or bleeding, blood in vomit or stools, muscle twitching or seizures, darkening of the skin tone, brittle nails, headache, frequent hiccups, and decreased feelings in the hands, feet, or other areas.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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