Chronic Kidney Insufficiency: Prevention

To prevent chronic renal insufficiency (chronic kidney failure), attention must be paid to reducing individual risk factors. Behavioral risk factors

  • Diet
    • Excessive consumption of fructose through soft drinks (two or more glasses of soda daily) [possible risk factor] – leads to kidney damage early on associated with albuminuria (abnormal excretion of albumin in urine; evidence of generalized capillary damage).
  • Consumption of stimulants
  • Overweight (BMI ≥ 25; obesity) – HDL levels and glomerular filtration rate decreased with increasing BMI; chronic kidney disease (defined as estimated glomerular filtration rate below 60 ml/min/1.73 m2) was diagnosed 2.6 years later in underweight than in normal weight individuals, whereas it was diagnosed 1.1 years earlier in overweight and 2.0 years earlier in obese individuals

Medications (nephrotoxic – drugs that damage the kidneys/nephrotoxic drugs).

  • ACE inhibitors (benazepril, captopril, cilazapril, enalapril, fosinopril, lisinopril, moexipril, peridopril, quinapril, ramipril, spirapril) and AT1 receptor antagonists (candesartan, eprosartan, irbesartan, losartan, olmesartan, valsartan, telmisartan) (acute: Decrease in glomerular filtration rate (GFR) associated with creatinine increase: ACE inhibitors as well as AT1 receptor antagonists abolish vasoconstriction (vasoconstriction) in the vas efferens, and a decrease in GFR and increase in serum creatinine result. Up to 0.1 to 0.3 mg/dl, this is usually tolerable. However, in the presence of hemodynamically relevant renal artery stenosis (not uncommon in patients with atherosclerosis/arteriosclerosis), GFR becomes markedly angiotensin II-dependent impaired, and administration of an ACE inhibitor or AT1 receptor antagonist may result in acute renal failure (ANV))!
  • Angiotensin receptor neprilysin antagonists (ARNI) – dual drug combination: sacubitril/valsartan.
  • Allopurinol
  • Antiphlogistic and antipyretic analgesics (non-steroidal anti-inflammatory drugs (NSAID), non-steroidal anti-inflammatory drugs) or non-steroidal anti-inflammatory drugs (NSAIDs* ) Caution: the combination of a diuretic, an RAS blocker, and an NSAID is associated with a significant risk of acute kidney injury:
    • Acetylsalicylic acid (ASA).
    • Diclofenac
    • Ibuprofen/naproxen
    • Indometacin
    • Metamizole or novaminsulfone is a pyrazolone derivative and analgesic from the group of non-acidic non-opioid analgesics (highest analgesic and antipyretic activity. Side effects: Circulatory fluctuations, hypersensitivity reactions, and very rarely agranulocytosis.
    • Paracetamol / acetaminophen
    • Phenacetin (phenacetin nephritis)
    • Selective COX-2 inhibitors such as rofecoxib, celecoxib (side effects: decreased sodium and water excretion, blood pressure increase and peripheral edema. This is usually accompanied by hyperkalemia (excess potassium))!
  • Antibiotics
  • Antifungals
    • Polyenes (amphotericin B, natamycin)
  • Chloral hydrate
  • Diuretics
  • Colchicine
  • Diuretics
  • D-Penicillamine
  • Gold – sodium aurothiomalate, auranofin
  • Immunosuppressants (ciclosporin (cyclosporin A)) – esp. ciprofloxacin plus ciclosporin A.
  • Interferon
  • Colloidal solution with hydroxyl starch
  • Contrast media – Of particular importance here are magnetic resonance imaging (MRI) contrast media containing gadolinium, which can lead to nephrogenic systemic fibrosis (NSF). Particularly affected by NSF are patients with a glomerular filtration rate (GFR) of less than 30 ml/min. [CKD stage 4]; iodine-containing radiographic contrast agents; [require prophylactic irrigation in renal insufficiency]EMA (European Medicines Agency): categorization of GBCAs (gadolinium-based contrast agents) in terms of NSF (nephrogenic systemic fibrosis) risk, based on thermodynamic and kinetic properties:High risk:
    • Gadoversetamide, gadodiamide (linear/non-ionic chelates) gadopentetate dimeglum (linear/ionic chelate).

    Medium risk:

    • Gadofosveset, gadoxetic acid disodium, gadobenate dimeglumine (linear/ionic chelates).

    Low risk

    • Gadoterate meglumine, gadoteridol, gadobutrol (macrocyclic chelates).

    If contrast agent is required: observe “renal protection” measures!

  • Lithium
  • Proton pump inhibitors (PPI; acid blockers).
    • “Atherosclerosis Risk in Communities” (ARIC): 10-year PPI use: rate of chronic renal failure in patients on PPI 11.8%, without 8.5%; rate of renal damage: 64%; two pills a day resulted in significantly more frequent damage: 62%
    • Geisinger Health System: observation period 6.2 years; rate of chronic renal failure disease: 17%; rate of renal damage: 31%; two pills a day resulted in significantly more frequent damage: 28%
  • Rast blockers: the combination of a diuretic, an RAS blocker, and an NSAID is associated with a significant risk of acute kidney injury.
  • Tacrolism (macrolide derived from the gram-positive bacterium Streptomyces tsukubaensis. Tacrolimus is used as a drug in the group of immunomodulators or calcineurin inhibitors).
  • TNF-α antibodies – adalimumab → IgA nephropathy (the most common form of idiopathic glomerulonephritis in adults, accounting for 30%).
  • Antivirals
  • Cytostatic drugs – carboplatin, cisplatin, cyclophosphamide, gemcitabine, iphosphamide (ifosfamide), methotrexate (MTX), mitomycin C, platinum (cisplatin).

Environmental stress – intoxications (poisonings).

  • Metals (cadmium, lead, mercury, nickel, chromium, uranium).
  • Halogenated hydrocarbons (HFCs; trichloroethene, tetrachloroethene, hexachlorobutadiene, chloroform).
  • Herbicides (paraquat, diquat, chlorinated phenoxyacetic acids).
  • Mycotoxins (ochratoxin A, citrinin, aflatoxin B1).
  • Aliphatic hydrocarbons (2,2,4-trimethylpentane, decalin, unleaded gasoline, mitomycin C).
  • Melamine

Prevention factors (protective factors)

  • Genetic factors:
    • Genetic risk reduction depending on gene polymorphisms:
      • Genes/SNPs (single nucleotide polymorphism; English : single nucleotide polymorphism):
        • Genes: UMOD
        • SNP: rs4293393 in the gene UMOD
          • Allele constellation: CT (0.76-fold).
          • Allele constellation: CC (0.58-fold)
  • Nutrition
    • Mediterranean diet: moderate fat and carbohydrate intake led to significantly 30% reduced odds of initial diagnosis of renal failure (odds ratio, OR 0.70); end point “albuminuria” was also significantly less common with healthy diet (OR 0.77):
      • Fat intake: monounsaturated fatty acids and omega-3 fatty acids predominated; saturated fatty acids were supplied in very low amounts.
      • The following foods are preferably consumed: cereal products, vegetables, salad, legumes, fruits and nuts and fish.
      • As low as possible proportions of red meat and meat products (sausages), sodium (table salt) and sweetened beverages.
  • Reduction of contrast agent-induced nephropathies: