Question of the Day?

How does alkali therapy prevent further progression of CKD?
A.) Decreases protein reabsorption
B.) Decrease renal blood pressure
C.) Decreases interstitial inflammation and complement activation
D.) Increases renal perfusion
Explanation
There have been several studies now to support the use of bicarbonate therapy in CKD to prevent progression. On of the larger studies done by Brito-Ashurst et al. in 2009 JASN showed significant improvement in decrease in GFR slope without any difference in edema, BP, or hospitalizations. The mechanism is due to decreased tubular interstitial damage by limiting urinary cytokines, endothelin, and TGF-beta.
-Adrian