The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of your spine. Healthy kidneys filter about a half cup of blood every minute, removing wastes and extra water to make urine. The urine flows from the kidneys to the bladder through two thin tubes of muscle called ureters, one on each side of your bladder. Your bladder stores urine.
The kidneys are powerful chemical factories that perform the following functions:
Without this balance, nerves, muscles, and other tissues in your body may not work normally.
How do kidneys work?
Each of kidneys is made up of about a million filtering units called nephrons. Each nephron includes a filter, called the glomerulus filters your blood, and the tubule returns needed substances to blood and removes wastes.
As blood flows into each nephron, it enters a cluster of tiny blood vessels – the glomerulus. The thin walls of the glomerulus allow smaller molecules, wastes, and fluid (mostly water) to pass into the tubule. Larger molecules, such as proteins and blood cells, stay in the blood vessels.
As the filtered fluid moves along the tubule, the blood vessel reabsorbs almost all of the water, along with minerals and nutrients your body needs. The tubule helps remove excess acid from blood. The remaining fluid wastes in the tubule become urine has been stored in the bladder for anywhere from 1 to 8 hours.
Chronic Kidney Disease
Chronic kidney disease (CKD) is defined as the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1,72 mt2, persisting for 3 months or more, irrespective of the cause. It is a state of progressive loss of kidney function ultimately resulting in the need for renal replacement (dialysis or transplantation). Kidney damage refers to pathologic abnormalities either suggested by imaging studies or renal biopsy, abnormalities in urinary sediment, or increased urinary albumin excretion rates. The 2012 KDIGO CKD classification recommends details about the cause of the CKD and classifies it into 6 categories based on glomerular filtration rate (G1 to G5 with G3 split into 3a and 3b). It also includes the staging based on three levels of albuminuria (A1, A2, and A3), with each stage of CKD being sub-categorized according to the urinary albumin-creatinine ratio in (mg/gm) or (mg/mmol) in an early morning “spot” urine sample.
The 6 categories include:
The three levels of albuminuria include an albumin-creatinine ratio (ACR)
The improved classification of CKD has been beneficial in identifying prognostic indications related to decreased kidney function and increased albuminuria. However, a downside of the use of classification systems is the possible overdiagnosis of CKD, especially in the elderly.
There are many causes of chronic kidney disease. The kidneys may be affected by diseases such as diabetes and high blood pressure. Some kidney conditions are inherited (run in families).
Etiology
The causes of CKD vary globally, and the most common primary diseases causing CKD and ultimately end-stage renal disease (ESRD) are as follows:
Homocysteine is an amino acid not supplied by the diet that can be converted into cysteine or recycled into methionine, an essential amino acid, with the aid of specific B vitamins. Homocysteine levels vary between men and women, with a normal range typically between 5 to 15 micromol/L. Hyperhomocysteinemia is when levels exceed 15 micromol/L. When homocysteine levels are greater than normal limits, it signifies a disruption in the metabolism of homocysteine. Elevated levels of homocysteine have been associated with increased cardiovascular, cerebrovascular, kidney disease and thromboembolic diseases.
Homocysteine accumulates unless it is removed either by the transsulphuration pathway or by methionine synthase in a transmethylation reaction requiring folate. A folate (in the form of 5-methyltetrahydrofolate) serves as a substrate in the latter reaction, its increased availability may enhance the removal of homocysteine.
Folate is the common name for pteroylmonoglutamate, a compound which occurs in nature conjugated to polyglutamate chains. Green vegetables, liver, and to lesser extent fruits are sources of folate provided they are not overcooked. Folate is needed for amino acid metabolism and DNA synthesis. Deficiency results in a megaloblastic anemia identical to that of vitamin B12 deficiency. Most evidence suggest that folate deficiency impairs the activity of thymidylate synthetase.
Folate is a water-soluble vitamin and is, therefore, removed by haemodialysis. Regular folate supplementation has been recommended for patients on dialysis. However, it has been shown that 2 mg folate/week is likely to be sufficient to maintain folate balance in a dialysis patient. Clinically relevant folate deficiency is unlikely to occur in CKD as long as dietary folate intake is adequate.
Folate deficiency should certainly be considered if a significant elevation in the mean cell volume or hypersegmented polymorphonuclear leucocytes is noted in a patient with chronic renal insufficiency. Moreover, in patient with malnutrition or those with a history of alcohol abuse, an assessment of folate status is recommended, as in these patient groups folate deficiency is relatively common.
Some abnormalities of folate metabolism appear to be specific for CKD. Early evidence that the intracellular transport of folate is altered in renal failure was reported in the 1970s. Moreover, it has been observed that serum folate is disproportionately elevated in relation to tissue folate stores in dialysis patients. Significant folate deficiency is relatively rare in well-nourished dialysis patients, folate supplementation has become an important part of the management of hyperhomocysteinaemia.
Why folate supplementation is essential for chronic kidney disease patient?
So, in patients with chronic kidney disease need folate supplementation for meeting the body’s folate requirement.
PT. SIMEX PHARMACEUTICAL INDONESIA as one of the pharmaceutical companies in Indonesia presents HY-FOLIC® products as supplement containing biologically active form of Folate (5-MTHF). HY-FOLIC® as active folate is not forming unmetabolized folic acid (UMFA) which is elevated in patients with folic acid. HY-FOLIC® has better absorption than folic acid; and practical to be consumed. HY-FOLIC® has FDA, EFSA approval and HALAL certificate.
