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Planning Diets for
PRACTICAL8 PLANNINGDIETSFOR Renal Diseases
RENALDISEASES
Structure
8.1 Introduction
8.2 Renal DiseasesAn Overview
8.2.1 Glomerulonephritis/AcuteGlomerularnephritis
8.2.2 NephroticSyndrome
8.2.3 ChronicRenalFailure(CRF)
8.2.4 AcuteRenalFailure/AcuteKidneyInjury
8.2.5 End-StageRenalDisease(Dialysis)
8.2.6 Nephrolithiasisor RenalCalculi
8.3 Review Exercises
Activity 1: Diet Plan for Glomerulonephritis
Activity 2: Diet Plan for Nephrotic Syndrome
Activity 3: Diet Plan for Chronic Renal Failure
Activity 4: Diet Plan for Acute Renal Failure
Activity 5: Diet Plan for Dialysis
Activity 6: Diet Plan for Nephrolithiasis
8.1 INTRODUCTION
In this practical, our focus shall be on planning suitable diets for renal diseases. We
shall review the various renal problems followed by the nutrient requirements during
theseconditionsandthetranslationofnutritionalrequirementsintosuitablefoodsources
as per the RDI so as to result in the development of an appropriate diet. Before you
start studying this practical, we suggest you look up Unit 16 in the theory course
Clinical and Therapeutic Nutrition (MFN-005) which presents a detail review on the
various renal disorders covered in this practical.
Objectives
After undertaking this practical you will be able to:
describe the different renal disorders,
discuss the dietary management of the renal disorders, and
plan diets for patients suffering from glomerulonephritis, nephrotic syndrome,
chronic/acute renal failure, end-stage renal disease and nephrolithiasis.
8.2 RENALDISEASES–ANOVERVIEW
Renal disease or diseases of the kidney are among the most ‘critical to treat’
disorders. Their treatment and management is still a challenge to medical science.
Despite receiving prompt and efficient treatment; many of these diseases leave
degenerative diseases that may increase the risk for the development of renal failure
with advancing age.
Glomerulonephritis, nephrotic syndrome, chronic/acute renal failure, end-stage renal
disease and nephrolithiasis are the most common forms of renal diseases. In the
subsequent section, we shall learn about different types of renal disease and their 173
dietary management.
Clinical and 8.2.1 Glomerulonephritis
Therapeutic Nutrition Glomerulonephritis,asyoumayrecallstudying,referstoinflammationofthenephrons;
thekeyfunctionalunit ofthekidney(s).Itgenerallyoccursduetotheantigen-antibody
reactions that occur in response to a particular infection (generally a streptococcal
infection). It is characterized by fever, uremia (accumulation of nitrogenous waste
products and other urinary constituents in blood), oedema, hypertension and oliguria/
anuria (reducedor nourineoutput becauseofreducedGFR).Figure8.1illustrates the
flowdiagramforthedevelopmentofglomerulonephritis.Goingthroughtheflowchart
will help you recapitulatetheprogression of glomerulonephritis about whichyou have
already studied in Unit 16 in the theory course.
Inflamed/damaged (scar) Nephrons
Leakage of plasma Acidosis
proteins andblood
cells in urine Reduced GFR ( 50%)
Oliguria
(reduced urine output; ½ - 1 Litre/day)
Reduced excretion of sodium Oedema
Hypertension
Hyperkalemia Cardiac arrest
Elevated levels of urea Anorexia
andcreatinine in blood } Nausea
Vomitting
Lowfood intake
Tissuecatabolismto
release energy &
protein for basal
needs
Figure 8.1: Flow diagram for glomerulonephritis
Thetreatment of glomerulonephritis is based on antibiotic therapy, complete bed rest
andmaintenanceofoptimumnutritionalstatus. Let us reviewthedietarymanagement
of glomerulonephritis in greater details.
Dietarymodifications of bothmacro-andmicronutrients arerequiredfor theeffective
management of glomerulonephritis and is based on the following objectives:
Objectives
Theobjectives of dietary management of glomerulonephritis are to:
cure the underlying disease,
reduce/prevent the severity of oedema and uremia,
maintain fluid and electrolyte balance,
maintain nitrogen balance, and
help in maintaininganadequatenutritionalstatus.
The nutrient needs for glomerulonephritis are enumerated next.
Energy: The total calories provided through diet to the patient depend upon the
presence/absence of fever, current activity level (ambulatory/complete bed rest) and
present body weight. Elevation of body temperature results in an increase in basal
metabolic rate (BMR) and hence the energy intake may be increased by about 10%.
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When patients are suggested complete bed rest; their energy expenditure on Planning Diets for
routine activities is minimal. In such cases, the energy intake may be reduced by 5% Renal Diseases
to 10% from the levels suggested by RDI for non-ambulatory patients. Adults may
need 30-40 Kcal/kg dry weight and children about 100 Kcal/kg dry weight or more,
based on age.
Protein: The protein intake should be calculated in accordance with the severity of
uremia(bloodureanitrogenlevels(BUN)andoliguria.Initially,0.6to0.8gprotein/kg
ideal body weight (IBW) is provided using principally high quality protein. Normal
levels of protein (1 g/kg IBW) may be provided if BUN levels remain within the
normal range.
Note: If the patient is suffering from oedema, the present body weight should
not be used to calculate his protein intake. In such cases, the protein intake may
becalculated on the following basis:
Theweight documented in his previous medical records (< 6 mths).
Calculate patient’s IBW based upon his height by using the formula:
Men:48kgfor first 5ft + 2.7 kg for each additional inch
Women:45.5kgforfirst5ft+2.3kgforeachadditionalinch. (±10%forsmall/
large build in both cases)
Sincetheproteinintakeis restricted, wemust layemphasis onhighbiologicalvalueor
good quality proteins. Generally, proteins present in animal foods contain a higher
proportion of essential amino acids as compared to those of plant origin. Eggs, milk
and certain milk products (curd, paneer), meat, fish, poultry, whole pulses/legumes
andtheir products particularly soyabean, soya-milk, tofu, texturized soya protein can
help in improving the essential amino-acid content of the diet. Since cereals (wheat,
wheat products, rice, maize etc) are poor sources of good quality protein; they are
generally substituted by starch rich foods (potato, colocasia, yam, sago, arrowroot
flour etc). Sago khichdi, scrambled egg, halwa, cottage cheese preparations, tofu or
dalstuffedroti, substitutionofsoyamilkforwater inthepreparationofpulses/legumes/
vegetables/kneading of dough are good options for feeding these patients.
Asample menu for a glomerulonephritis patient is included here for your reference.
Sample Menu
EarlyMorning Tea (Cream substituted for milk)
Arrowroot biscuits
Breakfast Sagoporridge
Potato stuffed roti
MidMorning Carrot halwa/ Potato halwa
Lunch Vegetable Preparation
Egg/Meat Preparation
Arrowroot and wheat flour chappati
Evening Tea Sago vada
Tea
Dinner Meat/paneer preparation
Vegetable preparation
Chappati
SujiLadoo
Bed Time Sago-cornpudding
Next, let us study about the nephrotic syndrome.
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Clinical and 8.2.2 Nephrotic Syndrome
Therapeutic Nutrition Nephroticsyndromereferredtoas‘Nephrosis’, is characterizedbyimpairednephrons
function and reduced reabsorptive capacity of renal tubules which results in massive
proteinuria and severe oedema. It generally occurs among children. The clinical
symptomsincludeproteinuria,haematuria,hyperalbuminemia,periphraloedema,ascites,
malnutrition etc. Figure 8.2 illustrates the progressive damage of nephrons a a result
of nephrotic syndrome.
Progressive Damage of Nephrons
Increased amount of proteins filtered through
Glomecular basement membrane
Anaemia Proteinuria
Hypothyroidism Hypoalbuminemia Peripheral oedema
and
Lowplasma osmotic ascites
pressure
Reduced plasma volume
Reduced renal blood flow
Enhanced renin angiotensin
aldosterone mechanism
Increased reabsosption of
sodium and water
Figure 8.2: Flow diagram for nephrotic syndrome
The treatment of nephrotic syndrome is based on the cure of the underlying cause,
maintain optimum nutritional status so as to prevent the onset of complications and
handle undernutrition effectively. The dietary requirements for nephrotic syndrome
patients is highligted next.
Energy: Most of thenephrotic syndromepatients areseverely malnourished and in a
catabolic state. Adequate amount of energy is required to promote a positive energy
balance so as to promote effective utilization of dietary proteins for the synthesis of
blood proteins and also to prevent subsequent weight loss. The energy intake should
beincreasedby10%i.e.around35-40Kcal/kgidealbodyweightincaseofadultsand
about 100 Kcal/kg body weight for children.
Protein: Protein intake of 0.8 g/kg ideal body weight plus 1 g/g of proteinuria is
recommended. This helps in maintaining a positive nitrogen balance which helps to
promote hepatic synthesis of albumin and replenish body stores of plasma proteins.
Emphasis shouldbelaid onhigh biological value proteins such as milk, curd, paneer,
egg whites, lean meats such as poultry/marine foods and whole pulses/legumes.
Although animal proteins contain a higher proportion of essential amino acids as
compared to plant proteins; they are also rich sources of sodium.
Acombination of plant and animal protein food sources may be included in the diet.
Besides, we should employ alternative methods of food preparation such as sprouting
andfermentationwhichhelptoimprovethebio-availabilityofproteins.Sproutedgrain/
legumes (rajmah, wholegreen gramdal, horsegram, Bengal gram, wholewheat) may
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