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

01/25/2026

Klotho is not just another protein.

It is a kidney-derived longevity factor that quietly protects blood vessels, regulates phosphate, and restrains some of the most dangerous complications of chronic kidney disease.

As kidney function declines, Klotho levels fall. The consequences are profound:

👉 Phosphate retention increases

👉 FGF23 signaling becomes maladaptive

👉 Blood vessels calcify instead of flex

👉 Cardiovascular risk rises sharply

This is one reason vascular calcification is not simply a calcium problem. It is a Klotho deficiency problem.

The most compelling part?

Klotho appears to be modifiable. Exercise, vitamin D optimization, phosphate restriction from ultra-processed foods, and targeted nutritional strategies may help preserve this protective pathway.

Questions worth asking:

Should Klotho be viewed as a biomarker of kidney resilience, not just disease?
Can preserving Klotho slow vascular aging in CKD?
Are we intervening too late, after Klotho has already collapsed?

Drop your thoughts or questions below. This pathway deserves far more attention in kidney and cardiovascular care.

Read the blog here: [https://inkidney.com/klotho-in-kidney-health/]

01/24/2026

🎧 New blog out today 🩺

Noise Pollution And Kidney Disease: The Silent Stressor You Have Not Considered

When we talk about kidney health, we focus on diet 🥗, blood pressure 💉, diabetes, and toxins. But there is another stressor hiding in plain sight: noise 🔊.

Chronic exposure to traffic 🚗, aircraft ✈️, construction 🚧, industrial noise, or even loud indoor environments is not just annoying. It activates the body’s stress response ⚠️, raises cortisol and blood pressure, disrupts sleep 😴, increases inflammation 🔥, and alters kidney blood flow over time. These are the same pathways that drive hypertension and chronic kidney disease progression.

Emerging human studies now link long-term noise exposure to lower eGFR, higher creatinine, increased albuminuria, and higher CKD prevalence, especially in people with diabetes or existing kidney risk 🧬. Noise deserves a seat at the table in integrative kidney care.

Have you ever thought about sound as part of your kidney health environment? 🤔

Do you notice symptoms worsening in noisy settings?

What strategies help you protect your sleep and stress levels? 🌙🧘‍♂️

Read the blog here: [https://f.mtr.cool/ojgngaxyxk

Drop your questions, thoughts, or experiences below 👇

01/23/2026

🧠💬 What does a kidney-friendly plate actually look like?

We get this question all the time—and the answers might surprise you.

🥦🍎🥩 Curious whether all fruits and veggies are safe for your kidneys?

Wondering if meat still has a place in your diet? Or how gut health ties into kidney health? Let’s talk about it.

We released our e-book, Fundamentals of a Plant-Based Diet for Kidney Health, packed with practical guidance—and we’d love to hear what YOU think.👇

📘 Inside you’ll find:

🔹 Evidence-based food recs tailored to kidney health
🔹 The truth about meat on a kidney-friendly diet
🔹 Gut health strategies to support kidney function

👥 Let’s start a conversation:

What’s been the most confusing part of managing your kidney diet?

Have you tried a plant-based approach—what worked (or didn’t)?

What questions do you still have about food and kidney function?

👇 Drop your thoughts, experiences, or questions in the comments—we’re here to learn together.

🛍️ Grab the full guide here:

https://inkidney.com/product/fundamentals-of-a-plant-based-diet-for-kidney-health/

01/22/2026

Let that sink in.

Dementia and chronic kidney disease are not separate diseases running on parallel tracks. They are biologically connected through vascular injury, inflammation, uremic toxins, insulin resistance, and oxidative stress.

When kidney function declines:

• Uremic toxins accumulate and affect the brain

• Blood vessels stiffen and cerebral blood flow drops

• The blood–brain barrier becomes more vulnerable

• Inflammation and oxidative stress accelerate cognitive decline

This means cognitive changes in CKD are not inevitable aging. They may be signals of systemic injury that starts in the kidneys.

Equally important, many of the same strategies that slow kidney disease progression may also protect the brain:

• Blood pressure and insulin resistance control

• Reducing uremic toxin burden

• Anti-inflammatory, nutrient-dense diets

• Exercise, sleep, and stress regulation

Questions worth asking:

• Should cognitive screening be routine in CKD care?
• Can earlier kidney intervention reduce dementia risk?
• Are we missing reversible contributors to cognitive decline in kidney patients?

Drop your questions or thoughts below. This is a conversation nephrology and neurology need to have together.

Read the blog here: [https://inkidney.com/dementia-and-chronic-kidney-disease/]

01/21/2026

That single shift changes everything.

The adrenal–kidney connection is often overlooked, yet it may explain why so many people with CKD struggle with hypertension, muscle loss, insulin resistance, poor sleep, inflammation, and higher cardiovascular risk, even when their labs seem “stable.”

In CKD, cortisol:

• Loses its normal circadian rhythm

• Stays elevated in the evening

• Has a prolonged half-life due to reduced kidney clearance

• Continues to exert harmful metabolic and vascular effects

This is not simply “stress.”

It’s hormonal dysregulation driven by impaired kidney-adrenal feedback.

The kidney isn’t just a passive victim here. It plays an active role in cortisol metabolism, conversion, and clearance. When kidney function declines, cortisol biology changes — and those changes may quietly accelerate CKD progression and cardiovascular risk.

Important questions worth asking:

• Should cortisol patterns be evaluated in CKD care?
• Are sleep disruption, muscle loss, and insulin resistance hormonally driven in kidney disease?
• Can lowering evening cortisol improve outcomes beyond blood pressure control?

Drop your thoughts or questions below. This is where nephrology, endocrinology, and integrative medicine intersect.

Read the blog here: [https://inkidney.com/the-adrenal-kidney-connection/]

01/19/2026

STUDY SPOTLIGHT

Dietary Salt & Protein Intake and Urinary Cystine Excretion in Cystinuria

“A 10-gram increase in daily protein intake raised urinary cystine by 164 µmol — but cutting salt barely moved the needle.”

A new longitudinal study of 41 adults with recurrent cystine stones examined how diet impacts urinary cystine excretion using five 24-hour urine collections per patient over multiple years.

What the researchers found might surprise you:

Key Findings:

• Protein intake matters. Higher protein (estimated by urinary urea) showed a moderate within-person effect:

→ Every 10 g/day increase = 164 µmol rise in urinary cystine.

• Salt intake? Not so much. Changes in urinary sodium (dietary salt) showed minimal and statistically nonsignificant impact on cystine excretion.

• Cystine levels fluctuate dramatically, even within the same person — underscoring why management is notoriously challenging.

Why this matters:

For decades, cystinuria patients have been told to restrict salt and protein. But this real-world study suggests that protein moderation has a more apparent effect, while salt restriction alone is unlikely to reduce stone risk meaningfully.

The interventions that actually move the needle?

• High fluid intake (2.5–3 liters of urine/day)

• Urine alkalinization to increase cystine solubility

These remain the most powerful tools for preventing stone recurrence.

Read the study here: [https://academic.oup.com/ckj/article/18/11/sfaf329/8305909]

Tell us:

👉 Should protein restriction be emphasized more strongly in cystinuria counseling?
👉 Are we overestimating the role of salt in cystine stone formation?
👉 How do you approach dietary management in cystinuria?

Share your thoughts — clinicians, patients, and researchers are welcome.

01/18/2026

Most people have never heard of the glycocalyx, yet it may be one of the most important and overlooked defenders of kidney health.

Think of the glycocalyx as a microscopic protective gel that lines blood vessels and kidney filters. When it’s healthy, it:

• Protects kidney filters

• Keeps protein in the blood where it belongs

• Reduces inflammation and scarring

When it’s damaged by high blood sugar, oxidative stress, inflammation, or elevated uric acid, the kidney’s filter becomes leaky.

That leak shows up clinically as protein in the urine, often one of the earliest warning signs of kidney disease.

This blog breaks down how glycocalyx injury connects diabetes, hypertension, uric acid, and CKD progression and why restoring this “invisible barrier” may be a powerful therapeutic target.

Questions worth asking:

• Is proteinuria a sign of structural damage rather than just high pressure?
• Could protecting the glycocalyx slow CKD progression earlier than we think?
• Are we missing vascular health as a root driver of kidney disease?

Drop your questions or thoughts below. This is where kidney care moves from numbers to mechanisms.

Read the blog here: [https://inkidney.com/glycocalyx-kidney-health/]

01/17/2026

That’s not wellness hype — it’s physiology.

In a previous blog, we explored how cold showers may support kidney health, not through detox myths, but through real biological mechanisms: vascular tone, inflammation control, autonomic balance, and circulation.

Cold exposure causes a brief, controlled stress that:

• Improves blood flow dynamics

• Lowers inflammatory signaling

• Reduces cortisol and stress load

• Stimulates the vagus nerve

• Enhances renal perfusion

For patients with chronic kidney disease, circulation, inflammation, sleep, and autonomic balance matter just as much as labs. Simple practices that improve these systems deserve serious attention.

This raises important questions:

• Can controlled hormetic stress improve kidney resilience?
• Are we underusing nervous system regulation in CKD care?
• Who benefits — and who should avoid cold exposure?

As always, context matters. Cold therapy is not for everyone, but when used thoughtfully, it may be a powerful adjunct.
Curious to hear your experience or questions — have you tried cold exposure, and how did your body respond?

Read the blog here: [https://inkidney.com/the-five-benefits-of-cold-showers-for-kidney-health/]

01/14/2026

This idea challenges a common assumption in kidney care.

In CKD, inflammation, oxidative stress, and tubular injury increase mitochondrial energy demand, especially in the renal tubules.

B vitamins aren’t just “general supplements” — they are core cofactors for ATP production, antioxidant defense, and cellular repair inside the kidney.

Yet many CKD patients are:

• On protein-restricted diets

• Limiting potassium- and phosphorus-rich foods

• Losing water-soluble vitamins through urine or dialysis

All of this raises an important question:

👉 Are we under-recognizing functional B vitamin insufficiency in kidney disease?

This blog explores:

• Why B2 and B3 are critical for renal mitochondria
• How CKD alters B vitamin requirements
• When supplementation makes sense
• Why methylated vs non-methylated forms matter for some patients

Questions worth discussing:

• Should B vitamins be considered metabolic support in CKD, not just “nutrition”?
• Are fatigue and low energy in CKD partly mitochondrial and micronutrient-driven?
• Should renal multivitamins be more personalized?

We’d love to hear your thoughts and questions.

Read the blog here: [https://inkidney.com/b-vitamins/]

01/12/2026

STUDY SPOTLIGHT

Fibroblast Growth Factor 23, Urinary Phosphate & CKD Progression

“High FGF23 didn’t just predict faster CKD progression — the risk doubled when the kidneys couldn’t excrete phosphate effectively.”

A new study of 946 adults with CKD reveals a powerful pairing:

FGF23 levels + 24-hour urinary phosphate excretion may identify who is most likely to progress rapidly toward kidney failure.

Key findings:

• Over ~27 months, 181 participants reached kidney failure or lost 40% of their eGFR.

• Those with the highest FGF23 levels had more than double the risk of CKD progression.

• The relationship was significantly stronger in people with low urinary phosphate excretion — meaning their kidneys were retaining phosphate, straining FGF23 regulation.

• Fractional excretion of phosphate did not modify the relationship.

Why this matters:

FGF23 elevation is the body’s early warning signal of phosphate overload — a driver of mineral dysregulation, vascular calcification, inflammation, and kidney decline.

When phosphate isn’t being excreted, FGF23 rises even higher, and the progression risk accelerates.

This study suggests:

• FGF23 could become a key biomarker for CKD risk stratification, not just a lab value we note in passing.

• Managing phosphate burden — diet, binders, and addressing gut-kidney-mineral interactions — may be more important than we think.

• The combination of biomarkers may help clinicians intervene earlier before irreversible decline occurs.

Read the study here: [https://shorturl.at/8zjwO]

👉 Should FGF23 testing become routine in CKD care?

👉 How should we rethink phosphate management in early-stage CKD?

Share your thoughts below.

01/11/2026

This is the question behind today’s blog highlight: Is organic food better for kidney health?

While organic eating isn’t about perfection or purity, it is about toxic load.

Research shows that certain pesticides used in conventional agriculture are nephrotoxic, meaning they can damage kidney tissue over time. That risk matters even more for people with reduced kidney clearance, CKD, or metabolic disease.

Organic foods tend to offer:

• Lower pesticide residues

• Reduced exposure to nephrotoxic chemicals

• Potentially lower cadmium content

• Higher antioxidant density in some crops

Is organic food a cure for kidney disease? No.

But could it reduce cumulative toxin exposure that the kidneys must process every single day? Possibly — and that’s worth discussing.
Important questions this raises:

• Should toxin exposure be part of routine CKD counseling?
• Are “normal” pesticide levels really safe for impaired kidneys?
• Is a targeted organic strategy (like avoiding the dirty dozen) enough?

We’d love to hear your thoughts.

Do you prioritize organic foods for kidney or metabolic health? Why or why not?

Read the blog here: [https://inkidney.com/is-organic-food-better-for-kidney-health/]

01/10/2026

🆕 New Blog Out Today: Five Benefits of Zinc for Kidney Health

Zinc deficiency is not a footnote in kidney disease. It is common, underrecognized, and potentially modifiable.

👉As kidney function declines, zinc levels often fall. Yet zinc plays a critical role in:
👉Protecting kidney tissue from oxidative stress and fibrosis
👉Competing with toxic metals like cadmium, lead, and mercury
👉Supporting appetite, nutrition, and protein intake in CKD and dialysis
👉Improving red blood cell production and anemia management
👉Reducing chronic inflammation that drives CKD progression

Emerging data suggest that adequate zinc status is associated with slower kidney decline, particularly in diabetic kidney disease, and may improve resilience against environmental toxin exposure.

The bigger question is not “Should zinc ever be considered?”

It is “Why are we not assessing it more often in CKD?”

This blog breaks down:

✔️ Who is most likely to be zinc deficient
✔️ How zinc interacts with toxins, inflammation, and mitochondria
✔️ When food may be enough and when supplementation deserves consideration
✔️ Why zinc must be used thoughtfully to avoid mineral imbalances

I’d love to hear from you:

Have you ever checked zinc levels in CKD patients?

Have you seen appetite, anemia, or inflammation improve with correction?

What questions do you have about zinc dosing or safety?

Drop your thoughts below, and let’s discuss.

Read the blog here: [https://f.mtr.cool/hjhlmeizxr

Dr. Isreb- The Integrative Nephrologist

01/25/2026

01/24/2026

01/23/2026

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01/10/2026

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Monday	8am - 5pm
Tuesday	8am - 5pm
Thursday	8am - 5pm
Friday	8am - 5pm