The Ins & Outs of Polycystic Kidney Disease (PKD)

Polycystic kidney disease (PKD) is one of the most common genetic disorders and is one of the leading causes of end stage renal disease (ESRD). Today I wanted to have a look at what PKD is and the role natural therapies can play in the management of PKD and its related complications.

So let’s dive right in….

What is polycystic kidney disease?

PKD is a genetic disorder that causes many fluid-filled cysts to grow in the kidneys. Unlike the usually harmless simple kidney cysts that can form in the kidneys later in life, PKD cysts can change the shape of the kidneys, making them much larger than they should be and taking the place of normal kidney tissue. With less normal kidney tissue, the kidneys cannot function as well and eventually, the kidneys may fail. 

PKD can also cause other complications, or problems, such as high blood pressure, cysts in the liver and problems with blood vessels in your brain and heart.

There are two main types of PKD:

1.   Autosomal dominant PKD (ADPKD)- the most common form of PKD (about 90% of cases) and is usually diagnosed between the ages of 30 and 50, when signs and symptoms start to appear. Autosomal dominant means you can get the PKD gene mutation, or defect, from only one parent. Researchers have found two different gene mutations that cause ADPKD. Most people with ADPKD have defects in the PKD1 gene, and 1 out of 6 or 1 out of 7 people with ADPKD have a defective PKD2 gene. 

2.   Autosomal recessive PKD (ARPKD)- this is a much less common form of PKD. It is typically a childhood disease that is often diagnosed soon after birth. Autosomal recessive means that for a child to have this disorder, both parents must have and pass along the gene mutation.

https://www.nature.com/articles/s41572-018-0047-y?utm_source=twitter&utm_medium=social&utm_content=organic&utm_campaign=NRRJ_2_SJB_nrdp_editorial_tweet#citeas

Signs and symptoms of PKD

ADPKD doesn’t generally cause any signs or symptoms until the cysts are a half inch or larger in size. 

Signs and symptoms include:

•     Hypertension (high blood pressure)
•     Pain in your back and side
•     Blood in the urine
•     Urinary tract infections
•     Kidney stones
•     Enlarged and painful abdomen
•     Abnormal heart valves

Early signs of ARPKD in the womb are larger than normal kidneys and a smaller than average size baby, a condition called growth failure. However, some people with ARPKD do not develop signs or symptoms until later in childhood or even adulthood. 

Complications of PKD

While the kidneys are the organs that are primarily affected by PKD, it can also affect other parts of the body. Some of the complications of PKD may include:

•     High blood pressure
•     Urinary tract infections
•     Kidney stones
•     Liver cysts
•     Cysts in your pancreas
•     Heart valve problems
•     Colon problems
•     Brain aneurysms
•     Diverticular disease

https://www.researchgate.net/publication/49806892_TRPP_channels_and_polycystins

Now, I can’t really talk about PKD without talking about hypertension (high blood pressure).

https://www.jscimedcentral.com/RenalMedicine/renalmedicine-1-1001.pdf

Hypertension is the most common clinical manifestation with the greatest impact on kidney function in PKD patients. 

Hypertension is present in 50-70% of ADPKD patients and often occurs before renal function starts to decline. Enlarging cysts may press on blood vessels in the kidneys which reduces blood flow to some parts of the kidney. Sensors in the nephron react as though blood pressure in the kidney is low which triggers the secretion of an enzyme called renin which in turn generates a hormone called angiotensin which constricts blood vessels causing high blood pressure.

High blood pressure is a major contributory factor for the increased cardiovascular morbidity and mortality in people with ADPKD. This means that optimal blood pressure control is essential to improve the prognosis of cystic kidney disease and the associated cardiovascular diseases. Studies show that better blood pressure control doesn’t just reduce the burden of cardiovascular complications but also slows the growth of cysts.

Natural treatment of PKD

When we’re talking about natural treatment of PKD we are looking to improve overall wellbeing and maintain current kidney function for as long as possible rather than reversing kidney disease. Natural treatment does not remove the cysts, but we have found that it prolongs kidney function.

Also, with PKD, it’s not just the kidneys we need to consider. High blood pressure, blood vessel dysfunction, systemic inflammation and hardening of the arteries (atherosclerosis) are all found at a very early stage of the disease and are responsible for increasing both cardiovascular risks and progression towards ESRD. 

Diet and lifestyle Tips

Here are some of the key diet and lifestyle changes we recommend following if you have PKD:

• Limit sodium intake- studies have shown an association between dietary salt intake and the rate of progression of ADPKD. Also helps with blood pressure control. 

• Limit protein intake- higher protein intake has been associated with a faster decline in kidney function.

• Maintain a healthy weight- studies show that a higher BMI is associated with greater increase in kidney size, faster decline in kidney function and increased rate of progression of PKD. Maintaining a healthy weight also helps to lower blood pressure and reduce other cardiovascular risk factors. 

• Caloric restriction- many animal models of ADPKD have shown that reducing food intake (by 10%-40%) reduces number and size of cysts, scarring of the kidneys, inflammation and damage to the kidneys. Caloric restriction has been studied in humans and shows numerous benefits when done appropriately such as reducing cholesterol and triglycerides, lowering blood pressure, improving measures of inflammation, reducing insulin resistance and improving glucose control and metabolic syndrome. Based on the positive results in animal models of ADPKD, clinical trials are currently running to study caloric restriction in adults with PKD. 

• Time restricted eating- time restricted eating is a type of intermittent fasting which has also been studied in animals with PKD and shows similar benefits to caloric restriction. In one specific study, animals that were subjected to time restricted feeding had significantly reduced disease progression, lower kidney weight and improved kidney function compared with animals who ate the same number of calories but didn’t undergo time restricted eating. Clinical trials on time restricted eating are currently running in adults with PKD. 

• Control blood glucose levels- people with ADPKD and diabetes have larger kidney volumes, earlier age at diagnosis of high blood pressure and may progress to ESRD faster compared to those without diabetes so managing blood glucose levels is extremely important. Studies have also shown that even in adults without diabetes, having a higher blood sugar level can contribute to faster progression of disease. 

• Manage blood pressure- one of the primary treatments of PKD is the management of high blood pressure because high blood pressure contributes to progression of PKD. High blood pressure represents the most important modifiable risk factor of PKD so early and effective management of blood pressure is very important to slow down progression of PKD and prevent the occurrence of cardiovascular events. 

Herbal and Nutritional Supplements

The following herbs and nutrients may be beneficial in the management of PKD and its complications.

Astragalus membranaceus- Astragalus is one of the most widely used herbs in Traditional Chinese medicine for treating kidney disease. It helps to lower blood pressure, controls blood sugar levels, reduces inflammation and oxidative damage and reduces fibrosis or scarring of the kidneys.

Rehmannia glutinosa- Rehmannia has a protective effect on the kidneys and helps to slow down the progression of kidney disease. It reduces inflammation and has antioxidant effects, lowers blood sugar levels and inhibits the expression of angiotensin II which contributes to elevated blood pressure in people with PKD. 

Dan Shen (Salvia miltiorrhiza)- Dan Shen protects the kidneys from damage and is a key herb when it comes to preventing and treating cardiovascular diseases like hardening of the arteries, blood clots and high blood pressure. Dan Shen can also help to prevent fibrosis or scarring of the kidneys. Fibrosis is associated with an increased rate of progression to ESRD in people with ADPKD. 

R-Alpha lipoic acid- alpha lipoic acid is one of the key nutrients when it comes to the treatment of kidney disease. It has strong antioxidant and anti-inflammatory effects, helps to lower blood sugar levels and improves insulin resistance. Many studies have shown that alpha lipoic acid can improve vascular function and decrease atherosclerotic plaques which cause hardening of arteries and increases the risk of heart attacks and strokes while also lowering cholesterol levels. Alpha lipoic acid also improves blood vessel function and can assist with lowering blood pressure.

Coenzyme Q10- CoQ10 is an important antioxidant and anti-inflammatory. It also helps to boost energy production within the body, making it an important treatment for fatigue but also for providing energy for optimal functioning of all organs including the kidneys. It also has particular benefits in cardiovascular disease including heart failure, high blood pressure and high cholesterol.

Vitamin E- vitamin E is one of nature’s most potent fat-soluble antioxidants and has strong anti-inflammatory actions. It also protects the heart, lowers cholesterol, reduces blood pressure and can reduce the risk of blood clots forming in blood vessels. 

Selenium- selenium is particularly beneficial in reducing inflammation and providing antioxidant support. Adequate selenium levels also reduce the risk of heart disease.

Vitamin C- vitamin C helps to lower inflammation and provides antioxidant support while also protecting the kidneys and heart from damage caused by reduced blood supply and can help to prevent blood clots from forming within the kidney and blood vessels. 

But don’t forget….

Make sure you speak to your doctor or naturopath before starting on any new supplements to make sure they are appropriate for you. Also, if you are thinking of implementing caloric restriction or time restricted eating I do recommend doing this under professional supervision as once again, this may not be appropriate for everyone. 

So there you have it, a comprehensive look at PKD and how natural therapies can assist in maintaining kidney function and preventing some of the potential complications of PKD. 

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