Chronic kidney disease (CKD):

The major role of the kidney is to cleanse or purify the blood. If kidneys are damaged or fail to work, the nitrogenous wastes are not filtered out and accumulate in the blood instead. This gives rise to several complications and if left unattended for long may eventually lead to death.

 Kidney failure and its types:

Kidney failure can be broadly classified into two types:

●Acute kidney failure- This is marked by the sudden onset of impaired kidney function.

●Chronic kidney failure- This is marked by a gradual decline of kidney function.

Decrease and decline in renal function over 3+ months can be termed as chronic kidney disease. It is much more fatal than acute kidney disease. CKD can be attributed to a decline in the GFR (Glomerular filtration rate). Glomeruli are tufts of capillaries present in the kidney

There are five stages of chronic kidney disease and the end-stage CKD (chronic kidney disease) can be life-threatening. 

GFR is the prime marker of CKD. The normal GFR is 125mL/min. Estimated GFR is based on creatinine, and cystatin C.

• Stage I- 90mL/min.
• Stage II-60-80mL/min..
• Stage III b) 30-44mL/min
• Stage IV)15-29mL/min
• Stage V) Less than 15 mL/min.

Diagnosis of kidney ailments:

• A simple blood test is needed to estimate the GFR. GFR is an abbreviation for glomerular filtration rate. A GFR level indicates how well the kidneys are working.
• Imaging examinations or scans: This could be an ultrasound or a CT scan. This generates an image of the kidneys and urinary tract. It can determine whether the kidneys have kidney stones or other issues. People who are at high risk of kidney disease should have this test as part of their regular checkups with a healthcare provider.
• Apart from blood tests, imaging or scans, urine tests or kidney biopsy can be done. Biopsy involves taking a small sample of kidney tissue with a needle for its microscopic observation. Non-invasive tests need to be conducted prior to the invasive tests. 

Protein and kidney health: Patients can be given a food frequency questionnaire and then followed over the time to gather data on their protein intake. People who have higher intake of protein usually have a shorter decline in kidney function. Proteinuria is a common problem (presence of protein in the urine). Kidneys are made of filters called glomerulus. Proteins that are essential for every single activity. Kidneys should not leak proteins. When proteins leak is mild (no color or smell difference) but when high (urine is foamy and frothy).

Albumin is a type of protein found in the blood. Protein is required by one’s body. It is an important nutrient that aids in muscle growth, tissue repair, and infection resistance.

Protein can “leak” out of one’s kidneys into their urine if the kidneys are damaged. Protein in the urine is referred to as “albuminuria” or “proteinuria.” Albumin (30 mg) is excreted from the kidneys and is the most important protein.

The normal range of other proteins (200 mg).

Higher risk groups: 

• Diabetic patients.
• Individuals with high blood pressure or hypertension.
• Those who have a family history of kidney failure
• Individuals aged 65 and up.
• Certain ethnic groups, such as African Americans, Hispanics, Asians, and American Indians, are underrepresented.

 A biopsy of the kidney. This can assist in determining what caused the kidney disease and how much damage has occurred to the kidneys.

Symptoms of CKD:

Unless the disease is severe, most people with kidney disease have no symptoms. However, the below mentioned symptoms can be observed: 

• Swelling.
• Breathing difficulty.
• Urinating more frequently.
• Hiccups.
• Tiredness (feeling tired).
• Sleeping problems.
• Vomiting and nausea.
• Diabetes and hypertension.
• The inflammation on nephrons can be attributed to the primary problems with nephrons filter head. Injury, swelling).

Primary Causes:

• Long standing diabetes over a long period of time. Should monitor sugar levels regularly, control sugar level and consult a nephrologist.
• High B.P, accelerate kidney damage.
• Glomerulonephritis nephrotic syndrome in non- diabetic patients protein content should be kept in check. 

Benefits of low protein diet:

• Blood, urea, nitrogenous wastes are reduced, protein metabolism products are less reduced as well and less urea is made when low protein is there. So, less protein leakage is seen. 
• Decreased glomerular hyperfiltration, decreases proteinuria, decreases uremic toxins.
• Decreases oxidative stress.
• Decreased phosphorus, parathyroid hormone (PTH).
• Decreased insulin resistance.
• Decreased blood pressure, better uremic control, delayed dialysis initiation.
• Reduced metabolic acidosis. 

All the aforementioned parameters help preserve kidney function.

Risks associated with a low protein diet: 

Malnutrition, increased chronic inflammation, high blood pressure cause diabetes and cause stress. This circles back to cause renal problems. Low protein diet is recommended and doesn’t necessarily have to be a vegan diet. 

People on dialysis should focus on getting adequate proteins. Kidney disease and cancer cases necessitates conflicting dietary guidelines. Deterred glucose homeostasis, inadequate calorie intake (<30 calorie/kg/dl). Protein loss and hyper catabolism, worsening acidemia, protein energy wasting.

Low protein dietary regimen: A low protein diet can be useful for patients with albuminuria and associated CKD. They are as follows:

Plant based diet whole grain, white grains, healthy fats must include proteins, carbohydrates, fats (macronutrients) fats and carbohydrates need to be adjusted to replenish the loss of proteins. So, switch to healthy fats. Avocado, olive oil, etc, sesame oil, garnish it with salad. Nut, butter, bread, corn tortilla, wheat tortilla, oatmeal, cereals, grits, apple, pear, paste, rice, noodles, rice milk, guava, peach, pineapple, grapes, berries, bell peppers, okra, potatoes, pineapple, cabbage, cauliflower, carrot, asparagus, gourd. 

High protein animal diet:

Eggs, egg white, cow milk, cottage cheese, greek yogurt, cheddar cheese, T bone beef steak, lamb, pork loin, chicken breast, turkey bast, salmon, tuna(caned), shrimp.

High protein plant sources that can useful alternatives to animal proteins:

Soy milk, black beans, pinto beans, lentils, tofu, edamame, tempeh, quinoa, almonds, pumpkin seeds, peanuts, peanut butter, chia seeds, hemp seeds. Patients need to focus on the benefits rather than mourning over bad eating habits and not being able to enjoy animal proteins. Pasta is very good, zucchini noodles, spaghetti squash, add more fibers and reduce proteins, lentils are added instead of ground beef fibers. Lentils tossed with species. Easy to cook and cheaper than meat. 

Protein is needed to help build muscle, heal from injury and fight infection. Too much protein can cause build up in the blood. A kidney is not a protein restricted diet. The goal is to eat in proper amounts, but avoid eating too much. Most people need between 40-65 grams of protein/day. Recommended daily protein depends on factors such as body size, stage of the kidney disease, nutritional status. Protein intake should not be too low. Loss of muscle mass.

There are two types of proteins individuals eat: animal protein is high value protein. Example lean red meat, chicken, turkey, pork, eggs and daily products. Vegetables or plant proteins are low value proteins, for example breads, grains, dried beans, rice, and pasta. Choosing high value protein with low cholesterol level is also recommended for CKD patients. Example fish, seafood, and low- fat dairy products. 

Conclusion: Proteinuria is an early sign of chronic kidney disease, which is defined by a gradual loss of kidney function that may eventually necessitate dialysis or a kidney transplant. However, a low protein-based diet like that of a vegan or plant-based diet might be useful in combating albuminuria and associated renal complication in patients. Adherence to a strict low protein diet can improve the quality of life of the patient.