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Open AccessArticle

Kidney Response to the Spectrum of Diet-Induced Acid Stress

by Nimrit Goraya 1,2 and Donald E. Wesson 3,4,*
1
Baylor Scott & White Health Department of Internal Medicine, Temple, TX 76508, USA
2
A&M Health Science Center College of Medicine, Temple, TX 76508, USA
3
Baylor Scott & White Health Department of Internal Medicine, Dallas, TX 75210, USA
4
A&M Health Science Center College of Medicine, Dallas, TX 75210, USA
*
Author to whom correspondence should be addressed.
Nutrients 2018, 10(5), 596; https://doi.org/10.3390/nu10050596
Received: 10 April 2018 / Revised: 1 May 2018 / Accepted: 8 May 2018 / Published: 11 May 2018
(This article belongs to the Special Issue Nutritional Prevention and Acid Base Status)
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. View Full-Text
Keywords: alkali; base; bicarbonate; chronic kidney disease; diet; protein alkali; base; bicarbonate; chronic kidney disease; diet; protein
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Goraya, N.; Wesson, D.E. Kidney Response to the Spectrum of Diet-Induced Acid Stress. Nutrients 2018, 10, 596.

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