The kidneys are vital organs responsible for filtering waste products and excess fluids from the blood to form urine, maintaining electrolyte balance, regulating blood pressure, and producing hormones that help control various bodily functions (18). Kidney disease is growing at an alarming rate, currently affecting 37 million Americans. However, kidney disease is often preventable, and the progression of kidney disease to failure can be slowed or stopped with proper monitoring and intervention.

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What Is Kidney Disease?

Kidney disease, also known as renal disease or nephropathy, refers to a condition in which the kidneys are damaged and unable to perform their functions effectively. Acute kidney injury (AKI) and chronic kidney disease (CKD) are two distinct kidney-related conditions with differing characteristics and prognoses. 

AKI is characterized by a sudden decline in kidney function, typically occurring within hours to days. AKI is often reversible when the underlying cause is promptly identified and treated. In contrast, CKD is a long-term condition that develops gradually over months or years, marked by a persistent and progressive deterioration of kidney function. CKD is typically considered irreversible. While its progression can be slowed or managed with lifestyle changes, medications, and treatment of underlying conditions, it rarely results in a return to normal kidney function. Furthermore, it can progress to end-stage renal disease (ESRD), where the kidneys lose their ability to function entirely. (7, 16) 

What Causes Kidney Disease?  

AKI can be triggered by factors that decrease blood flow, induce direct damage, and block urinary outflow from the kidneys. Causes of AKI include severe injuries, infections, dehydration, overuse of medications (e.g., NSAIDs), surgery, and cancer. (1) 

Several factors and underlying conditions can contribute to the development and progression of CKD. Diabetes and hypertension (high blood pressure) are the two most common causes of CKD. If left uncontrolled over time, elevated blood pressure and blood sugar can damage the small blood vessels in the kidneys, reducing their ability to function effectively and leading to kidney damage. (4) 

Other factors contributing to CKD include glomerulonephritis (inflammation of the glomeruli), polycystic kidney disease (a genetic disorder characterized by cysts forming in the kidneys), and autoimmune diseases like lupus. Additionally, certain infections, exposure to nephrotoxic substances, and recurrent kidney stones can also play a role in kidney damage and the development of CKD. Lifestyle factors, such as smoking, obesity, and overuse of certain medications, can exacerbate the risk of CKD. (4, 5) 

Kidney Disease Symptoms

Kidney disease, whether it's AKI or CKD, can have a range of signs and symptoms. The specific symptoms can vary depending on the type and stage of kidney disease. Some common symptoms of kidney disease include:

• Changes in urination: decreased urine output (oliguria), increased frequency of urination at night (nocturia), or complete cessation of urination (anuria)
• Foamy or bloody urine
• Swelling and fluid retention in the lower extremities and face
• Fatigue and weakness
• Reduced appetite
• Unintended weight loss
• Nausea and vomiting
• High blood pressure
• Itchy skin
• Muscle cramps and restless legs syndrome
• Difficulty concentrating
• Shortness of breath

What Are the Benefits of Regular Lab Testing for Patients With Kidney Disease?

Early detection and management of kidney disease are crucial for slowing its progression and preserving kidney function. Treatment options vary depending on the underlying cause and the stage of the disease. Therefore, regular lab testing helps diagnose kidney disease in its early stages and allows for tracking changes in kidney function over time. These tests enable healthcare providers to tailor and monitor treatment strategies, ultimately improving long-term outcomes in patients with kidney disease.

Top Labs To Run Bi-Annually On Patients With Kidney Disease

Proper laboratory tests are critical in providing proactive care and improved patient outcomes. Functional medicine labs are powerful tools for evaluating and monitoring patients with kidney disease.

Kidney Function Testing

CKD is categorized into five stages based on the level of kidney function, as determined by the glomerular filtration rate (GFR) and albumin-to-creatinine ratio (ACR). These stages help healthcare providers assess the severity of the condition and guide treatment decisions. A kidney function panel includes GFR, albumin, creatinine, and important biomarkers to evaluate kidney health and monitor disease progression.

Comprehensive Metabolic Panel (CMP)

In addition to markers of kidney function, a CMP is a more extended panel that includes electrolytes, blood sugar, and blood proteins. This metabolic screening is an important tool in monitoring blood chemistry to screen for and monitor CKD-related health complications, including electrolyte imbalances, metabolic acidosis, and hypertension. 

Hemoglobin A1c (HbA1c)

HbA1c is a marker of long-term blood sugar control, reflecting average blood sugar levels over the past three months. Many individuals with CKD have or are at risk of developing diabetes. Monitoring HbA1c helps doctors diagnose and manage diabetes, which can worsen the progression of kidney disease.

Complete Blood Count (CBC)

A normocytic, normochromic anemia can result from CKD due to the kidney's reduced production of a hormone called erythropoietin. A CBC measures various parameters related to red blood cells, including hemoglobin and hematocrit, which aids in diagnosing and monitoring anemia.

Lipid Panel

Abnormal lipid metabolism, especially hypertriglyceridemia, is common in patients with kidney disease. The American College of Physicians (ACP) recommends that all patients with CKD be evaluated for dyslipidemia using a lipid panel and treated as necessary.

Vitamin D

The kidneys are responsible for converting vitamin D to its active form; with declining kidney function in the advanced stages of CKD, vitamin D deficiency can occur (17). Vitamin D deficiency has been linked to health conditions, including osteoporosis, cardiovascular disease, depression, and cancer. Vitamin D status can be measured with a simple blood test. 

Thyroid Panel

The kidney plays a role in the metabolism and excretion of thyroid hormones, so CKD is associated with a higher prevalence of overt and subclinical hypothyroidism. A thyroid panel evaluates thyroid hormones to diagnose thyroid disorders secondary to CKD.

NutrEval

Malnutrition, associated with rapid progression to ESRD and mortality, is common in patients with advanced CKD because of dietary restrictions, reduced appetite, and lower food intake. A comprehensive nutritional analysis, such as Genova Diagnostic's NutrEval, helps healthcare providers identify patients at risk of malnutrition and its associated complications. Furthermore, these results guide dietary and supplemental recommendations to ensure CKD patients meet specific nutritional intake goals.

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Summary

Regular monitoring of specific laboratory tests is paramount in the comprehensive care of patients with kidney disease. These routine assessments offer valuable insights into kidney function, electrolyte balance, anemia status, bone health, and overall nutritional well-being. By carefully selecting and consistently ordering these tests, healthcare providers can detect early changes, tailor treatment plans, and manage kidney disease progression effectively.