This article follows on from my previous article on ‘The Role of the Mitochondria in Chronic Disease’. Today I will speak exclusively on the role mitochondria play in kidney disease. Just to recap and keep you up to date, the main job of mitochondria is to produce energy through a process called oxidative phosphorylation. Mitochondria are also known as the ‘powerhouse’ of the cell, they provide our body with the fuel it requires to complete our activities throughout the day. In most cases, mitochondrial disease is a genetic disease that can be passed from parents to their children. Mitochondrial dysfunction has been found to play a key role in chronic health issues such as neurodegenerative diseases; Alzheimer’s Disease, Parkinson’s Disease and Huntington’s Disease, metabolic disorders, acute and chronic kidney disease, cardiomyopathy, cancer and obesity.
The kidney is a vital organ, it requires a load of energy to carry out its daily activities such as maintaining body metabolism, plasma haemodynamics, nutrient reabsorption, secreting certain hormones, and regulating blood pressure, and water and electrolyte balance. After the heart, the kidney comes second in mitochondrial count and oxygen consumption. Kidney disease has created an enormous financial burden on the healthcare system, there are limited therapeutic strategies to cure or slow disease progression, so finding different treatment options is important. As a result, mitochondrial-targeted therapies have become a focus. Research shows maintaining and supporting mitochondrial health can decrease kidney disease and progression.
Kidney disease can be classified into two categories;
- Acute kidney disease (AKD)
- Chronic kidney disease (CKD)
In acute kidney disease, we see rapid renal function decline. Electrolyte imbalances, fluid overload, severe acidosis, anaemia, uremic platelet dysfunction and multiorgan failure can be seen. In comparison, chronic kidney disease shows a loss of renal function over time. CKD can occur due to defects in glomerular filtration units or chronic tubular injuries which can lead to cardiovascular disease, malnutrition, bone loss and high blood pressure. Congenital and inherited kidney disorders, tumours and aging may also affect kidney function and impact other organ systems. All of these conditions have the ability to progress to end-stage kidney disease (ESKD).
What Have Mitochondria To Do With Kidney Disease?
Energy demands within the renal cells are tailored to each specific cellular function and as cellular energy demands are mostly met by mitochondria, this is where we see the bidirectional relationship between the two. Mitochondrial dysfunction is associated with almost all types of kidney disease.
Mitochondrial dysfunction and abnormalities will affect some cellular pathways which then leads to increased oxidative stress, apoptosis, fibrosis and microvascular loss. To perform its primary function, the regulation of body fluid composition through the filtration and reabsorption of material, kidneys will consume roughly 7% of daily ATP expenditure from the body.
The functional unit of the kidney is called the nephron, which is where this process occurs. Most of the energy required by the kidney is used for the reabsorption of solutes, which is done both passively and actively by the renal tubular cells. The renal tubular cells consume adenosine triphosphate (ATP), which we know is the main energy currency of cells. As you can see, these renal tubular cells are rich in mitochondria, showing, any mitochondrial injury can result in harmful consequences on renal cell function.
Mitochondrial Dysfunction leads to the decreased production of ATP leading to a reduction of renal function and kidney health.
As mitochondrial disease can impact so many different organs, it is really tricky to diagnose. There is no single laboratory test or diagnostic test that will exclusively diagnose this condition. Diagnoses will usually begin with a number of examinations and tests to help exclude other pathologies; this may include:
- Patient history
- Family history
- Complete physical examination
- Neurological examination
- Metabolic examination-Includes blood and urine testing and if required a cerebral spinal fluid test (spinal test)
Other tests may include:
- Magnetic resonance imaging (MRI)
- Electrocardiogram (EKG) for symptoms of heart disease
- Audiogram for hearing symptoms
- Blood test to detect any thyroid dysfunction
- Blood test to perform DNA genetic testing
- Retina exam for vision symptoms
Factors such as mitochondrial biogenesis (the process by which cells increase mitochondrial numbers) and turnover, autophagy (this is your body’s cellular recycling system, it allows the cell to discard the parts it does not need and repurpose the salvageable parts), bioenergetics (the major adaption of skeletal muscle to exercise training) and dynamics (mitochondria continuously change morphology to adapt to their environment and cellular energy needs) all regulate the conditions of the mitochondria.
The search for alternative and complementary medicine is growing in this area of health as patients search for other avenues to take responsibility for their own health and well-being. Traditional Chinese Medicine (TCM) is one modality that has gained more attention as its approach to health is multifaceted. TCM has been developed over centuries to help prevent and treat disease. TCM uses a mind-body approach which includes herbal medicine. The practitioner sees as the body as a whole, this modality does not just treat the disease alone.
As herbal medicine has an abundance of constituents and actions with therapeutic value, this approach to health is more holistic. Studies show that herbal medicine may relieve some of the symptoms associated with KD and may help slow the reduction of kidney function.
I provided some treatment considerations in my previous article ‘The Role of the Mitochondria in Chronic Disease’, please refer to this for information on more herbs and supplement options. Today I will look at curcumin and resveratrol and their role in mitochondrial and kidney health.
Curcumin is one constituent that has gained attention. Curcumin has been used as a spice and traditional medicine for centuries in both India and China. Curcumin has significant anti-inflammatory actions within the body. Chronic kidney disease is inflammatory by nature and is often associated with other inflammatory conditions such as cardiovascular disease and diabetes. In a review on ‘Curcumin and Chronic Kidney Disease’, findings suggested curcumin can dampen the generation and action of inflammatory molecules and may support those with CKD.
Studies have also shown that increased intestinal permeability will result in proinflammatory molecules, such as lipopolysaccharides and cytokines from the gut released into circulation, in conditions such as CKD, atherosclerosis and diabetes. It was found curcumin may help correct intestinal permeability.
In a small clinical study, 16 CKD patients received curcumin (824 mg purified turmeric extract, 95% curcuminoids), twice daily for 8 weeks. Creatinine and blood urine nitrogen did not change significantly, however, a marked reduction of inflammatory markers TNa, IL-6 and C reactive protein, was reported. There was also a significant reduction in their BMI.
Elevation of mitochondrial function has been found with curcumin treatment. Curcumin may Improve mitochondrial potential and ATP production and has been shown to have significant mitochondria-protective properties.
Resveratrol is a polyphenol found in grapes and berries, it possesses anti-inflammatory, hepatoprotective, neuroprotective and anti-diabetic properties. Studies suggest a diet rich in fruit and vegetables helps to protect against kidney disease and renal cancer. Resveratrol has been shown to reduce fibrosis, and oxidative stress and improves kidney structure and function.
In a 2019 study, resveratrol was also shown to reduce fibroblast proliferation and activation. This study also showed improved glucose homeostasis, reduced inflammation, increased kidney function and antioxidant activity in vivo animal models with diabetic nephropathy.
Resveratrol is a potent antioxidant that can act as a reactive oxygen species (ROS) scavenger. It has been shown to have protective effects against age-related disorders including renal disease. The health benefits of resveratrol are widespread and due to its low toxicity, it is worth considering as a treatment for preventing renal injury.
Although there is evidence complementary may alleviate renal injury by supporting mitochondrial function, a detailed understanding is still limited. Due to ongoing research in traditional and complementary medicine, stronger evidence to support its use will emerge over time. Curcumin and resveratrol both play a supportive role in mitochondrial health, in turn, they preserve mitochondria from damage. Thankfully, Traditional Chinese Medicine and complementary medicine are providing new ideas for the treatment of chronic kidney disease which are well worth exploring.
I look forward to seeing this information evolve over time.
I hope you enjoyed reading through the post, hopefully, it made sense and has given you more information to work with. Let me know by sharing this article with family and friends or by heading over to our Facebook page and leaving us a comment.
Always check with your health practitioner before taking on any new supplemental or herbal routine.