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Dr. Isreb- The Integrative Nephrologist, Vancouver, WA (2026)

06/25/2026

📰 The June 2026 Research & News Newsletter is now available on our blog.

This month's edition explores some of the most exciting developments in integrative nephrology, including:

📌 How gut bacteria may help mediate the kidney-protective effects of therapeutic diets
📌 Why creatine supplementation can raise creatinine without necessarily harming the kidneys
📌 New evidence suggesting prenatal fluoride exposure may influence kidney development through epigenetic changes
📌 A lifestyle medicine trial designed to improve long-term outcomes after kidney transplantation
📌 Research showing that microplastics may damage the kidney's filtration barrier
📌 Our Review Article of the Month: Diagnostic and Clinical Utility of Assessing Renal Functional Reserve

Every month, we review the latest kidney health research and translate the findings into practical, easy-to-understand insights for clinicians, patients, and anyone interested in optimizing kidney health.

Read the June newsletter on our blog today.

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Join our free Integrative Kidney Institute newsletter and receive monthly research updates, kidney health insights, and practical strategies for supporting kidney function.

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06/24/2026

💧 Can most recurrent kidney stones be prevented?

A new systematic review evaluated the evidence for preventing recurrent kidney stones in both adults and children.

The researchers found that several strategies consistently reduced the risk of stone recurrence in adults with calcium-based kidney stones:

👉 Increasing fluid intake
👉 Following a diet with normal-to-high calcium intake
👉 Reducing sodium intake
👉 Moderating animal protein consumption
👉 Using targeted therapies such as thiazide diuretics, potassium citrate, or allopurinol when appropriate

One of the most important findings is that adequate dietary calcium remains a cornerstone of kidney stone prevention, challenging the common misconception that people with calcium stones should avoid calcium-rich foods.

The review also reinforces the importance of lifestyle and nutrition as the foundation of stone prevention, with medications often serving as an adjunct rather than a replacement for dietary changes.

While these recommendations are supported by the best available evidence, the authors note that more research is needed, particularly in children and in areas such as imaging surveillance and long-term outcomes.

For many patients, preventing the next stone may depend less on finding a new medication and more on consistently applying a few proven habits.

❓What do you think is the most misunderstood aspect of kidney stone prevention: calcium, oxalate, sodium, or hydration?

Read the review here: [https://www.acpjournals.org/doi/10.7326/ANNALS-25-04452]

06/23/2026

Our blog highlight of the day is exploring one of the most overlooked ideas in modern nephrology:

The Brain-Gut-Kidney Axis.

For years, CKD and hypertension were treated like “plumbing problems.”

But emerging science says something radically different:
Your microbiome, your stress response, and your kidneys are constantly in conversation, and when that communication breaks down, the consequences ripple across the entire body.

Some key questions we should ALL be asking:

👉 Could treating gut imbalance help lower blood pressure?

👉 Are microbial toxins (like indoxyl sulfate and p-cresol) quietly accelerating CKD progression?

👉 Can stress-driven changes in the nervous system disrupt the gut and worsen kidney disease?

👉 And most importantly, are we missing early opportunities to intervene simply because we’re not looking at the whole system?

This axis may reshape the way we approach CKD prevention, hypertension management, and holistic kidney care.

We’d love to hear your thoughts:

💬 Have you seen gut health or stress meaningfully impact blood pressure or kidney function?

💬 Should microbiome testing or gut-focused therapies play a bigger role in CKD care?

💬 What part of the brain-gut-kidney connection do you find most intriguing?

Drop your questions and comments below... let’s talk about this emerging frontier.

📖 Read the full blog: [https://inkidney.com/the-brain-gut-kidney-axis-a-new-frontier-in-hypertension-and-chronic-kidney-disease/]

06/22/2026

Kidney nutrition is often discussed as if one diet works the same way for everyone.

But this study suggests the relationship between diet and kidney function may depend on s*x and hormonal status. 🧬

A cross-sectional study of more than 6,100 healthy adults from the CHRIS cohort examined how dietary patterns were associated with kidney function, measured by eGFR.

In men, greater adherence to a DASH-style diet was associated with better kidney function. A dietary pattern higher in whole grains, fruits, and legumes, and lower in red and processed meat, was also linked with better eGFR.

In women, the findings were more complex.

👉 Postmenopausal women appeared to have better kidney function with diets lower in meat and refined grains and higher in whole grains and dairy.
👉 In premenopausal women, a pattern higher in beef, beer, and nuts was associated with slightly worse kidney function. Interestingly, DASH diet adherence was not clearly associated with kidney function in women overall.

Why is this important?

This study reminds us that kidney nutrition is not one-size-fits-all.

S*x hormones, menopause, body composition, vascular health, insulin sensitivity, inflammation, and dietary patterns may all shape how food affects kidney function. 🩺

For integrative kidney care, this supports a more personalized approach:

🥗 What dietary pattern is the patient following?
🧬 Is s*x and hormonal status being considered?
🌾 Are whole grains, legumes, fruits, and fiber included appropriately?
🥩 How much red and processed meat is consumed?
🧪 Are kidney function, blood pressure, metabolic health, and inflammation being monitored?

The takeaway is not that DASH is unhelpful. The takeaway is that dietary recommendations may need to be refined based on the person in front of us.

Kidney nutrition should be personalized, evidence-informed, and responsive to biology, not just based on broad labels.

Read the study here:

[https://link.springer.com/article/10.1186/s12882-026-04896-z]

06/21/2026

Omega-3 fatty acids aren’t just “heart-healthy”—they’re emerging as one of the most impactful nutritional strategies for protecting kidney function.

From slashing inflammation and reducing proteinuria to lowering blood pressure and improving lipid profiles, Omega-3s directly target many of the root drivers of CKD progression.

Some studies even show benefits in IgA nephropathy and cardiovascular complications, the leading cause of death in CKD patients.

In this blog highlight, we break down how Omega-3s work, why quality matters, ideal dosing insights, and how to integrate them safely into kidney-focused care.

Are Omega-3s the most underused therapy in kidney health?

Swipe through and tell me what you think—questions and comments welcome.

Read the blog below [link in profile]

https://inkidney.com/omega-3-fatty-acids-in-kidney-disease/

06/20/2026

Heartburn meds are often seen as harmless.

In chronic kidney disease, they are not.

Proton pump inhibitors, antacids, sucralfate, bismuth, and even products like Alka-Seltzer can quietly worsen kidney outcomes through:

👉 Accelerating CKD progression
👉Causing electrolyte abnormalities (like low magnesium)
👉Aluminum accumulation and toxicity
👉Increased blood pressure and sodium load
👉 Masking early kidney injury

What makes this more concerning is that many of these medications are over-the-counter and taken long-term without reassessment.

In CKD, every medication matters, including those taken for “just reflux” or “indigestion.”

Questions worth asking:

Are you or your patients taking acid-suppressing meds long term?
Were they ever reassessed after CKD diagnosis?
Should safer alternatives or deprescribing be considered earlier?

Drop your questions or experiences in the comments. This is an area where small changes can make a big difference.

For more info, read the blog here: [https://inkidney.com/stomach-medications-in-chronic-kidney-disease/]

06/19/2026

💊 Could a newer acid reflux medication be a better choice for people with chronic kidney disease?

Potassium-competitive acid blockers (P-CABs) are a newer class of medications used to treat acid reflux and GERD. Unlike traditional proton pump inhibitors (PPIs), P-CABs provide rapid and sustained acid suppression through a different mechanism.

A recent study of more than 34,000 patients with chronic kidney disease found that those taking P-CABs had a lower risk of progressing to kidney replacement therapy compared with patients taking PPIs.

These findings are particularly noteworthy because previous studies have raised concerns about potential kidney-related complications associated with long-term PPI use.

Could the choice of reflux medication influence long-term kidney health?

While these results are encouraging, they should be interpreted carefully.

👉 This was an observational study, meaning it can identify associations but cannot prove that P-CABs directly protect the kidneys. More research, including randomized clinical trials and longer-term studies, is needed before firm conclusions can be drawn.

👉 Patients with advanced CKD were not extensively studied. As these drugs become more widely used, we still need more data in patients with stage 4-5 CKD.

👉 Indirect effects are possible. As with PPIs, profound acid suppression can alter magnesium absorption, the gut microbiota, and possibly mineral metabolism; further studies are needed to assess the effects of P-CABs on these issues.

Still, this study highlights an important principle in kidney care: medications prescribed for conditions outside the kidneys can sometimes significantly affect renal outcomes.

❓For patients with CKD who require long-term treatment for acid reflux, should P-CABs be studied as a preferred alternative to PPIs?

Read the study here: [https://f.mtr.cool/hzpztgkvgz

06/18/2026

💪 Muscle health may be one of the most overlooked predictors of survival in chronic kidney disease.

A new study from the UK Biobank found that patients with CKD who had both low muscle mass and increased fat infiltration within their muscles were more than four times more likely to die during follow-up compared with those with healthier muscle composition.

Importantly, this association remained significant even after accounting for age, diabetes, cardiovascular disease, physical activity, smoking, proteinuria, and hand grip strength.

The findings suggest that muscle health is not simply about strength or body weight. The quality of muscle matters too.

For years, nephrologists have focused on kidney function, blood pressure, and proteinuria. This study reminds us that maintaining healthy muscle may be another critical component of preserving health and longevity in CKD.

Muscle loss and fatty infiltration can be influenced by physical inactivity, insulin resistance, chronic inflammation, poor nutrition, hormonal changes, and aging, many of the same factors that contribute to kidney disease progression.

While MRI-based muscle analysis is not routinely available, this research highlights the importance of strategies that support muscle health, including resistance exercise, adequate protein intake when appropriate, metabolic health optimization, and reducing chronic inflammation.

❓Should muscle health become a routine part of CKD risk assessment and management?

Read the study here: [https://f.mtr.cool/nibdouvkyv

06/17/2026

🔍 Can kidney disease begin before kidney tests become abnormal?

A new review highlights the importance of renal functional reserve (RFR), the kidney's ability to increase its filtration rate when challenged by stressors such as a protein load.

Traditionally, we rely on serum creatinine, eGFR, and urine protein to detect kidney disease. The problem is that these markers often remain normal until significant kidney damage has already occurred.

Researchers suggest that a reduced renal functional reserve may reveal a hidden stage of kidney dysfunction known as subclinical chronic kidney disease, where the kidneys appear normal on routine testing but have already lost some of their ability to adapt to physiologic stress.

This concept may help explain why some patients develop acute kidney injury, medication-related kidney damage, or progressive CKD despite having "normal" kidney function tests beforehand.

As kidney medicine moves toward earlier detection and prevention, assessing how well the kidneys respond to stress may become just as important as measuring their function at rest.

❓Do you think future kidney evaluations should include dynamic tests that assess kidney reserve, not just static measurements like creatinine and eGFR?

Read the review here: [https://f.mtr.cool/txhlhyoocl

06/16/2026

Urinary citrate is best known for its role in kidney stone prevention. Citrate binds calcium in the urine and helps reduce the formation of calcium oxalate and calcium phosphate stones. 🧪🪨

But low urinary citrate may also tell us something deeper about kidney health.

One of the kidney’s important jobs is to help maintain acid-base balance. When the body has increased acid load, the kidney may respond by reabsorbing more citrate in the proximal tubule. That citrate can then be metabolized to help generate bicarbonate, which helps buffer acid.

The result?

Less citrate appears in the urine.

This means that low urinary citrate may be an early sign of acid retention, even before serum bicarbonate becomes abnormal and sometimes before a major decline in eGFR is obvious.

This matters because hidden acid retention may contribute to:

✅ Tubular stress
✅ Inflammation
✅ Fibrosis
✅ CKD progression
✅ Bone and muscle buffering
✅ Increased calcium stone risk

Low urinary citrate can also be influenced by diet and lifestyle, including high animal protein intake, low fruit and vegetable intake, ketogenic diets, diarrhea, metabolic acidosis, low potassium, and certain medications.

So when urinary citrate is low, the question should not only be:

“Is this patient at risk for kidney stones?”

But also:

“Is this patient showing early signs of acid-base stress?”

The bottom line:

Urinary citrate is more than a stone marker. It may be a window into early kidney stress, acid retention, and metabolic imbalance. 🌱

This is for educational purposes only and is not medical advice.

For more information, read this reference: [https://pubmed.ncbi.nlm.nih.gov/31215805/]

Dr. Isreb- The Integrative Nephrologist

06/25/2026

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Thursday	8am - 5pm
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