MNT---Kidney diseases

Dr. K. S. Abbasi
INSTITUTE OF FOOD & NUTRITIONAL
SCIENCES

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kidneys are two bean-shaped organs found on the left and
right sides of the body in vertebrates. They are located at
the back of the abdominal cavity in the retroperitoneal
space. In adults they are about 11 centimetres (4.3 in) in
length. They receive blood from the paired renal arteries;
blood exits into the paired renal veins. Each kidney is
attached to a ureter, a tube that carries excreted urine to
the bladder.
Function:
 Filtering system of the body
 Help to remove waste material from the body
 Help to maintain BP, RBC production
 Balance body fluids
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Damage factors:
 OTC drugs----Ibuprofen

 Certain anti-biotics

 Less intake of water---current situation in Pakistan

 High intake of sodium--- Reducing the ability of your kidneys to

remove the water
 Alcohol consumption irritates the kidneys and affects hormone
regulation of water balance in the body.
Risk Factors:
 10% of the global population is affected by chronic kidney disease.

 People of Black African and South Asian descent are 3-5 times
more likely to suffer from kidney failure (requiring dialysis)
 South Asian patients with diabetes----are 10 times more likely to
go on to have kidney failure.
 Genetics

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Kidney (Renal) Stones
 Renal stones are painful and can cause nausea, difficulty passing
urine and may progress to kidney disease if there is a blockage.
 A high salt diet has been associated with renal stones.
 Urinary calcium, the main constituent of renal stones, is increased
by a high salt diet and this increases the risk of stones.
 Avoid stone-forming foods:
 Beets, chocolate, spinach, tea, and most nuts are rich in oxalate,
and colas are rich in phosphate, both of which can contribute to
kidney stones.
 Pair calcium-rich foods with oxalate-rich foods.
 Chronic kidney stones are often treated with potassium citrate, but
studies have shown that limeade, lemonade and other fruits and
juices high in natural citrate offers the same stone-preventing
benefits.
 Eating less animal-based protein and eating more fruits and
vegetables will help decrease urine acidity and this will help reduce
the chance for stone formation.
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Calcium stones:
 Calcium is not the enemy.

 If you have high calcium in the urine then sodium reduction is

helpful for stone prevention.
 Instead of reducing your calcium intake, focus on limiting the
sodium in your diet and pair calcium-rich foods with oxalate-rich
foods.
Oxalate stones:
 Oxalate stones: fruits and vegetables, nuts and seeds, grains,
legumes, and even chocolate and tea
 Eating and drinking calcium and oxalate-rich foods together during
a meal is a better approach than limiting oxalate entirely because
oxalate and calcium are more likely to bind to one another in the
stomach and intestines before the kidneys begin processing,
making it less likely that kidney stones will form.

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Uric acid stones: Cut down on high-purine foods such as red meat,
organ meats, and shellfish, and follow a healthy diet that contains
mostly vegetables and fruits, whole grains, and low fat dairy
products.
 Limit sugar-sweetened foods and drinks, especially those that
contain high fructose corn syrup.
 Limit alcohol because it can increase uric acid levels in the blood
and avoid crash diets for the same reason.
 Eating less animal-based protein and eating more fruits and
vegetables will help decrease urine acidity and this will help reduce
the chance for stone formation.
Stone preventions:
 Reducing the amount of animal protein may help. Sources of
animal protein include beef, chicken, fish and eggs.
 Most people need only four to six ounces of high protein foods and
three servings of milk or cheese.
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Acute kidney Injury (AKI)
 An abrupt loss of kidney function that develops within 7 days.

 Acute kidney injury (formerly known as acute renal failure) is a

syndrome characterized by the rapid loss of the kidney's excretory
function and is typically diagnosed by the accumulation of end
products of nitrogen metabolism—Urea and Creatinine level
or decreased urine output, or both
 Can lead to number of complications, including metabolic acidosis,
high K levels, uremia, changes in body fluid balance, even can lead
to death.
 Can increase risk of CKD
 Management----treatment of underlying cause.
Causes: Excessive use of diuretics, side effects of many
medications, excessive vomiting, diarrhea, burns, sweating,
blood loss, chemotherapy, neurotoxic medications
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Symptoms
Edema, lethargy, confusion, nausea, vomiting, weight gain
Urine output
 Normal urine output is 1-2 ml/kg/hr.
 To determine the urine output of your patient, you need to know
their weight, the amount of urine produced, and the amount of
time it took them to produce that urine.
 Urine output should be measured at least every four hours if
possible.
 Oliguria (urine output less than 400 mL per day), Anuria (urine
output less than 100 mL per day), or normal volumes of urine
(non-oliguric acute kidney injury)
Diagnosis: The initial laboratory evaluation should include complete
blood count, measurement of serum creatinine level, HbA1C,
Albumin, electrolytes, Parathyriod Hormone (PTH).
Clinical Management: Patients with acute kidney injury generally
should be hospitalized unless the condition is mild and clearly
resulting from an easily reversible cause. Hemodynamically stable-
--normal, heart function, Normal BP and normal urine output
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Nutritional Management (AKI):
 From a nutritional point of view AKI can be divided into two
groups:
AKI in the non-catabolic state
 Causes includes Dehydration, certain medications and urinary
obstruction. Generally stable and where required any renal
replacement therapy (RRT) will usually be provided by
conventional haemodialysis (HD).
 Oral diet alone, or with the addition of nutritionally-dense
supplementary sip feeds will frequently be sufficient to meet the
patients’ needs. If not artificial nutrition support should be
implemented.
AKI in the catabolic state
 Causes includes sepsis and trauma, often have multi-organ failure
and will be managed on an ICU, complex therapeutic challenges.
PEW (protein energy wasting) is a frequent finding and is
associated with poorer patient outcomes in terms of length of
hospital stay, complications and mortality rates.
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 Protein turnover rates are increased and negative nitrogen balance
results. Nitrogen requirements are increased above normal and are
also influenced by the mode of RRT undertaken. Although hyper
catabolism cannot be reversed by simply increasing protein intake,
appropriate nutrition support will reduce nitrogen losses.
 Patients will usually require artificial nutrition support, particularly
if intubated and sedated.
 Wherever possible, this should be provided via the enteral route.
Standard formulae can be used, but nutritionally-dense feeds with
or without reduced electrolyte content are useful where the control
of fluid balance and/or serum phosphate and potassium levels
proves difficult

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Chronic Kidney disease (CKD)
Chronic kidney disease (CKD), also known as chronic renal disease, is
progressive loss in kidney function over a period of months or years.
The symptoms of worsening kidney function are not specific, and
might include feeling generally unwell and experiencing a reduced
appetite,
Key points: Early detection can help prevent the progression of kidney
disease to kidney failure.
 Heart disease is the major cause of death for all people with CKD.
 Glomerular filtration rate (GFR) is the best estimate of kidney
function.
 Hypertension causes CKD and CKD causes hypertension.
 Persistent proteinuria (protein in the urine) means CKD is present.
 High risk groups include those with diabetes, hypertension and
family history of kidney failure.
 African Americans, Hispanics, Pacific Islanders, American Indians
and Seniors are at increased risk.
 Two simple tests can detect CKD: blood pressure, urine albumin and
serum
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CKD and Diabetes:
 Diabetes happens when your blood sugar is too high, causing
damage to many organs in your body, including the kidneys and
heart, as well as blood vessels, nerves and eyes.
 High blood pressure, or hypertension, occurs when the pressure of
your blood against the walls of your blood vessels increases.
 If uncontrolled, or poorly controlled, high blood pressure can be a
leading cause of heart attacks, strokes and chronic kidney disease.
 Also, chronic kidney disease can cause high blood pressure. People
with Repeated urinary infections are also at risk of CKD.

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General Symptoms:
 feel more tired and have less energy

 have trouble concentrating

 have a poor appetite

 have trouble sleeping

 have muscle cramping at night

 have swollen feet and ankles

 have puffiness around your eyes, especially in the morning

 have dry, itchy skin

 need to urinate more often, especially at night.

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 Glomerular Filtration Rate (GFR).
 A blood test measures how much blood your kidneys filter each
minute
 The blood sample is sent to a lab. There, the creatinine level in the
blood sample is tested. The lab specialist combines your creatinine
level with several other factors to estimate your GFR. The formula
includes some or all of the factors like; age, blood creatinine
measurement, ethnicity, gender, height, weight etc.
 The GFR test is recommended for people with chronic kidney
disease. It is also recommended for persons who may get kidney
disease due to: People living with Diabetes, frequent UTI, heart
diseases, hypertension, family history of kidney disease, urinary
blockage

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General Nutritional Management

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Mineral nutritional therapy in Kidney disorder
Sodium: If kidneys are not working well, sodium and fluid build up in
body. This can cause high blood pressure and other problems like
swelling of ankles, fingers or eyes.
 Most processed foods are higher in sodium. Convenience means
that many of us end up eating less fresh foods which are important
for a healthy diet.
 Cereals and bread are popular foods that can contain higher levels
of sodium so check the label.
 Cook own meals from whole foods rather than buying processed
whenever you can.
 Eat only small amounts of high sodium foods.
 Check the ingredients list for hidden salts.
 Adding herbs and spices to fresh foods are a good way to add
flavour without the salt.
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Phosphorus:
 Phosphorus is a mineral found in many foods. Large amounts of
phosphorus are found in: n dairy products such as:
 Milk, cheese, yogurt, ice cream and pudding, nuts and peanut
butter, dried beans and peas such as kidney beans, split peas and
lentils n beverages such as cocoa, beer and dark cola drinks n bran
breads and bran cereals
 Eating high-phosphorus foods can raise the level of phosphorus in
blood. Kidneys may not be able to remove all of this extra
phosphorus
 To keep phosphorus at safe levels in blood, you may need to limit
phosphorus-rich foods.
 Patients may also need to take a type of medicine called a
phosphate binder.
 These binders are taken with your meals and snacks.

 Your doctor will tell you if you need to limit high-phosphorus

foods or take phosphorus binders.
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Potassium
 Nearly all foods contain some potassium. Many healthy foods like
fruits, vegetables and dairy are high in potassium. In kidney
disease, intake of these foods often needs to be controlled. This may
mean avoiding some fruits and vegetables altogether, while for
others a small serve and eating them less often may be enough.
 The amount of potassium depend on type of dialysis. i.e.
Hemodialysis (restrict potassium intake) & Peritoneal dialysis
(increase potassium intake), In Pakistan, Hemodialysis is mostly
preferred.
 Limit milk and milk products or replace with nondairy substitutes.

 Discard liquids from canned fruits and vegetables.

 Avoid salt substitutes and other seasonings with potassium.

 Read labels on packaged foods and avoid potassium chloride.

 Pay attention to serving size.

 Don’t skip dialysis or shorten treatment times.

 Leach high-potassium vegetables to remove some of the potassium.

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High Potassium Low Potassium High Potassium Low Potassium
Apples Carrots
Bananas Berries Dried beans and peas Cabbage
Dried fruits Fruit Cocktail (Not suitable Pumpkin Cauliflower
for Patients living with Diabetes)
Kiwi
Grapes (Not suitable for Patients Potatoes Cucumber
Mangos living with Diabetes) Spinach (cooked) Eggplant
Oranges & orange Peaches Sweet potatoes Green beans
juice Canned Pears (Not suitable Tomatoes, tomato Lettuce
Papaya for Patients living with Diabetes)
sauce Onion
Prune juice Pineapple
Plums Vegetable juices
Watermelon

High Potassium Low Potassium

Ice cream Soy milk and nondairy creamer, rice milk and
Milk almond milk.
Yogurt However these products are not available in
Pakistan. Also culturally not acceptable, thus it
is better to allow 0.5 to 1 cup of low fat milk or
low fat yogurt
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Fluid restriction therapy in Kidney Disorder
 Fluid restrictions are usually necessary when dialysis is initiated,
especially if dialysis only occurs three days a week and if urine
production is decreased.
 Build up of fluid can lead to shortness of breath, swelling, and high
blood pressure. There is a limit to the amount of fluid that can be
safely removed during dialysis.
 If fluid limits are exceeded and extra water must be removed,
negative effects such as muscle cramping, low blood pressure
leading to nausea, weakness, dizziness, and possibly extra dialysis
sessions to remove the fluid.
 Fluid restrictions vary for each individual.
 Factors in determining the amount of the restriction include weight
gain between treatments, urine output, and swelling.

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 Fluids are anything that is liquid at room temperature or melts at
room temperature. These include water, tea/coffee, milk, soft
drinks, juice, ice, ice cream, sherbet, gelatin, soups, liquid creamer,
alcohol, water, or beverage used for taking medicine.
 Limit high salt foods----less thirst.
 Suggest patients to take pills with mealtime liquids
 Drink from small glasses and cups.
 Drink only when feel thirsty.
 Use sour candy or gum to moisten mouth.
 Add some lemon juice to water or ice. The sour taste will help to
quench your thirst.
 Use ice cubes instead of liquids-----will last longer.
 Freeze 20 grapes and eat throughout the day as one of fruit
servings.

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