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Nutrients. 2018 May 11;10(5). pii: E596. doi: 10.3390/nu10050596.

Kidney Response to the Spectrum of Diet-Induced Acid Stress.

Author information

1
Baylor Scott & White Health Department of Internal Medicine, Temple, TX 76508, USA. Nimrit.Goraya@BSWHealth.org.
2
A&M Health Science Center College of Medicine, Temple, TX 76508, USA. Nimrit.Goraya@BSWHealth.org.
3
Baylor Scott & White Health Department of Internal Medicine, Dallas, TX 75210, USA. Donald.Wesson@BSWHealth.org.
4
A&M Health Science Center College of Medicine, Dallas, TX 75210, USA. Donald.Wesson@BSWHealth.org.

Abstract

Chronic ingestion of the acid (H⁺)-producing diets that are typical of developed societies appears to pose a long-term threat to kidney health. Mechanisms employed by kidneys to excrete this high dietary H⁺ load appear to cause long-term kidney injury when deployed over many years. In addition, cumulative urine H⁺ excretion is less than the cumulative increment in dietary H⁺, consistent with H⁺ retention. This H⁺ retention associated with the described high dietary H⁺ worsens as the glomerular filtration rate (GFR) declines which further exacerbates kidney injury. Modest H⁺ retention does not measurably change plasma acid⁻base parameters but, nevertheless, causes kidney injury and might contribute to progressive nephropathy. Current clinical methods do not detect H⁺ retention in its early stages but the condition manifests as metabolic acidosis as it worsens, with progressive decline of the glomerular filtration rate. We discuss this spectrum of H⁺ injury, which we characterize as “H⁺ stress”, and the emerging evidence that high dietary H⁺ constitutes a threat to long-term kidney health.

KEYWORDS:

alkali; base; bicarbonate; chronic kidney disease; diet; protein

PMID:
29751620
PMCID:
PMC5986476
DOI:
10.3390/nu10050596
[Indexed for MEDLINE]
Free PMC Article

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