A Presentation

On
Dietary Management for Kidney
Diseases

Presented by

Shusmita Dutta …………. FN18020

Presented to
Allabeen Karim …………. FN18022
Maymuna Faruk Trisha….FN18024 Mesbah Uddin Talukder
Sanzida zaman Ritu……..FN18026 Associate Professor
Al Amin…………………….FN18028 Dept. of FTNS
Abubakkar………………...FN18030 MBSTU
Shakil Ahmed……………. FN17041
 Filtering

4 basic
Restoring function Excreting
s

Secreting
The ultimate response on the
body….
• 1. Osmotic • 1. 1,25
pressure dihydroxy
• 2. cholecalcifer
ol
Electrolytic • 2.
balance Erythropoieti
• 3. pH Regulation production n
balance

Degradatio Releasin
n g
• 1. Parathyroid
• 2. Calcitonin • 1.Renin
• 3. Insulin
• 4. Gastrin
 What is
glomerulonephritis?
 Types of
Glomerulonephritis
1. Acute glomerulonephritis

-begins suddenly

-occurs mostly in children and young adults

2. Chronic glomerulonephritis

-develops gradually over several years

-occurs after the acute phase

Acute Glomerulonephritis

Symptoms
Causes Nausea
-a streptococcal Vomiting
infection of the Fever
respiratory tract, Hypertention
tonsillitis Proteinuria
- pneumonia or Hemanuria
scarlet fever Edema
 Diet therapy of Acute GN
• Sweetened fruit juices, ginger-lemon sherbet, high
carbs, low electrolyte supplements are given( when
nausea & vomiting in the acute stage).
• Fluid intake is monitored.
• A diet to maintain weight containing sufficient
calories should be given (when patient is able to eat).
• Protein (high biological value) is restricted to 40g.
• Sodium is limited to 1g/day.
• Vitamin C & B complex should be given.
 Chronic Glomerulonephritis

Symptoms
Protein , red & white blood cell
Causes s are observed in the urine
-untreated acute Frequent urination need to
GN urinate often in the night
Not checked by treatment, it
-an immunological can lead to renal failure
cause of unknown Tiredness
origin Edema
Hypertension
Blurred vision
 Diet modification of
chronic GN
• Protein losses must be covered by appropriate
increase in the diet of proteins of high biological
value.
• But protein in the diet must be reduced to 30 -40g
or less when the blood urea nitrogen rises with
worsening of kidney function.
• Sodium & potassium intake need to be restricted.
• Iron supplements may be added.
Calculation of meal pattern for
GN
a one day diet chart for 37g protein & 1800Kcal
energyNo. of Protein( Na(mg) Kcal/Svg Total
Food Footnotes
Items Svg g) Kcal
* Avoid high
Milk 1 8 120 80 80 sodium &
(skim) potassium –rich
Rice/ 6 12 175 70 420 foods.
bread * Avoid processed,
Egg 0.5 3.35 35 90 45 canned & sugary
products.
Meat/ 0.5 3.50 12.5 75 37.5
fish * Control blood
pressure &
Starchy 2 4 5 70 140 manage
roots phosphorus
Pulses 1 1 0 15 15 intake.
Fats & 6 0 0 45 270 * Consult with a
oils healthcare
professional or a
Sweets 2 0 0 250 500 registered
Tea 2 0 0 20 40 dietitian.
Nephrotic
Syndrome
What is Nephrotic syndrome
& how it occurs?
Nephrotic syndrome is a kidney disease that cause
your body to pass too much protein in your urine.

Nephrotic syndrome can be caused due to

progressive glomeronephritis, diabetes meltitus,
drugs and toxic venom.
Symptoms…
Proteinuria along with odema is present.

Large urinary losses of albumin and plasma protein

lead to tissue wastage, fatty liver, malnutrition.

Increased susceptibility to infection.

Dietary Treatment
Restricted protein, high carbohydrate, salt restricted moderate fat
with restricted fluid are recommend.
Low quality protein like pulses should be mixed with cereals and
milk to improve quality of protein.
High quality protein like egg and meat should be preferred.
Vitamin supplement especially vitamin c should be given.
To ensure protein use for tissue synthesis sufficient kcals must be
provided 2000 kcals is suggested.
Diuretics and sodium restrictions are used to prevent further
accumulation of fluid and prevent hypertension.
Low sodium foods can be consumed.
Potassium supplements are also essential.
 Renal failure

Renal Failure (2types)


Acute and

Chronic
 Acute renal failure(ARF)

ARF is an acute and potentially reversible irritability of

the kidneys to perform their normal functions to
maintain homeostasis.
~Causes
●
Loss of blood due to accidents and internal
hemorrhage
●
Loss of plasma as in burns
●
shock from surgery
●
Nephritis and Nephrosis can result in acute renal
failure
 Acute renal failure(ARF)
~ Symptoms
●
Uremia- There is retention of urea and others urinary constituents in
the kidney.
●
Azotemia- Accumulation of nitrogenous constituents in the blood
●
Azotemia- Accumulation of nitrogenous constituents in the blood
●
Oliguria- A scanty output of urine (less than 500 ml)
●
Anuria - Minimal production or absence of urine (less than 100 ml per
day)
●
Serum potassium levels are high when tissue proteins are broken
down to provide caloris
●
There is increased phosphates and sulphate with decreased sodium,
calcium and base bicarbonate
●
Patients are lethargic,anorexic,have nausea and vomiting.
 Acute renal failure(ARF)
Dietary Management
★Energy
●
A minimum of 600-1000 kcal is necessary. In the initial period
when oral intake is less due to vomiting and diarrhoea, 100 g per
24 hours intravenous glucose is given to reduce protein
catabolism.
★ Proteins
●
In the diuretic phrase 20-40 g protein is given. The protein
content of the diet varies depending on the urea content of the
blood.
★ Carbohydrates
●
A minimum of 100 g per day is essential to minimize tissue
breakdown.
 Acute renal failure(ARF)
Dietary Management
★ Sodium
●
Sodium restriction is judged based on the sodium loss in the urine.
Patients on the dialysis are permitted 1500 to 2000 mg per day.
★Fluids
●
Fluid allowance is regulated in accordance with urinary output.
★ Sodium
●
Sodium restriction is judged based on the sodium loss in the urine.
★ potassium
●
Potassium allowance is based on serum levels.
Hyperkalmia( potassium intoxication) has deleterious effects on the
heart. Potassium sources like tomato juice, coffee, tea, cocoa are
avoided.
 Chronic Renal Failure(CRF)
●
It is also known as uraemia as the level of urea in
blood is very high. It is a permanent irreversible
destruction of nephron leading to severe deterioration
of renal function, finally resulting to end stage renal
disease.
~Causes
1. Progression of acute nephritis or nephrosis.
2. Chronic infection of the urinary tract.
3. Kidney stones
4. High blood pressure
5. Exposure to toxic substances.
 Chronic Renal Failure
~Symptoms
The symptoms of the gastrointestinal tract are

Nausea or Vomiting.

The nervous system -patients are drowsy, irritable and sink to
coma.

If there is hypertension headache, dizziness, muscular
twitchings and failing vision occur

The functioning of the heart is seriously disturbed. Death
results when hyperkalemia block the contraction of the heart.

Dehydration,sodium depletion,high serum potassium,
acidosis, increased susceptibility to infection.
 Dietary management(CRF)
The objectives of treatment are-
To maintain optimal nutritional status:
1. To minimize uremic toxicity
2. To prevent protein catabolism
3. To improve the patients well being.
4. To delay the progression of renal failure.
5. To delay the need for dialysis.
 Dietary management(CRF)

★ Energy : For adults calorie needs range from

35-45 kcal per kg of ideal body weight or 2000 to
3000 kcal per day
★Protein: For intake can be reduced to o.5 g/kg
body weight per day.
★Carbohydrate & Fat: Elevated serum tri
glycerides common in chronic renal disease can
be lowered by controlling carbohydrate intake,
dietary cholesterol and polyunsaturated fat.
 Dietary management(CRF)

★ Potassium: This is restricted to 1ml mol/ kg

body weight.
★Sodium: Dietary sodium intake depends on the
amount of sodium in serum and urine.
★Vitamins: Losses of ascorbic acid and many B
vitamins occur during dialysis.
★Fluids: Intake of fluids needs to be monitored.
 Chronic Renal Failure

 Chronic renal failure is a condition involving a decrease

in the kidneys' ability to filter waste and fluid from the
blood.

 It is chronic, meaning that the condition develops over a

long period of time and is not reversible.

 The condition is also commonly known as chronic

kidney disease (CKD)
 Symptoms of CKD

The urge to urinate more frequently

Urine may be pale and foamy
Hypertension, also known as high blood pressure
Swelling of the legs
Poor appetite and Weight loss
Developing brown spots on the skin
Drowsiness or lack of concentration
Blood in the stool
Pain in the bones
Increased susceptibility to infection
 Causes of CKD
Diabetes: One in three adults with diabetes are likely to
develop chronic renal failure

Hypertension: One in five adults with high blood pressure are

likely to develop chronic renal failure

Polycystic kidney disease, a range of genetic disorders.

Nephrotic syndrome is a condition which damages the

glomeruli also called nephritis and glomerulonephritis.

Inflammation of the kidneys

 Diagnosis of CKD
Glomerular filtration rate (GFR): To check the filtration rate, a
blood sample is taken which is then tested in a lab. The results
are combined with factors including age, ethnicity, gender,
height and weight to estimate a person’s glomerular filtration
rate.

Creatinine clearance test: Another way of calculating the

glomerular filtration rate. To perform the test, a person needs
to collect all their urine for a 24 hour period and then provide a
blood sample. Comparing creatinine levels in the blood and
urine allows a person’s glomerular filtration rate to be
estimated.
 Treatment of CKD

Blood Pressure Control

Diabetes Management: It's essential to manage blood sugar
levels effectively through DDD (Diet, Dose and Discipline)
Dietary Modifications: Reducing sodium, potassium, and
phosphorus intake, as well as monitoring protein
consumption.
Medications: Medication may be prescribed to manage
complications such as anemia, bone disease, and electrolyte
imbalances.
Lifestyle Changes: Quitting smoking, avoiding excessive
alcohol consumption
Dialysis: Using a machine to filter the blood
Kidney Transplant
 Urolithiasis
• Urolithiasis refers to the formation of stones (also known
as calculi) anywhere in the urinary system, including
the kidneys and bladder. These hard deposits are
composed of minerals and salts that crystallize and stick
together within the urinary tract.
 Causes

– Diet: Consuming foods high in oxalate (e.g., spinach, chocolate, nuts) or

purines (e.g., organ meats, seafood) can contribute to stone formation.
– Dehydration: Insufficient fluid intake leads to concentrated urine,
increasing the risk of stone formation.
– Medical Conditions: Conditions like hyperparathyroidism, gout, and
urinary tract infections can increase the risk.
– Genetics: A family history of kidney stones may predispose an
individual.
– Medications and Supplements: Certain medications and supplements
can promote stone formation.
 Types

Types of Stones:

– Kidney Stones (Renal Calculi): These form within the

kidneys and can vary in size. They may remain in the
kidney or move into the ureters (the tubes connecting
the kidneys to the bladder).

– Bladder Stones: These develop in the bladder and can

cause discomfort and urinary symptoms.
 Symptoms

– Pain: Severe, sharp pain in the side and back

(below the ribs) that may radiate to the lower
abdomen and groin.

– Urinary Symptoms: Pain or burning sensation

while urinating, frequent urination, and cloudy or
foul-smelling urine.

– Other Signs: Pink, red, or brown urine, nausea,

vomiting, and fever if an infection is present
 Treatment

– Small stones may pass naturally with pain

management and increased fluid intake.

– Larger stones or those causing complications

may require medical intervention, including
surgery or lithotripsy (breaking the stones using
shock waves).
 DIALYSIS

a procedure to remove waste products and excess

fluid from the blood when the kidneys stop working
properly.
 Dietary Management
 Maintain protein and kilocalorie balance.

 Prevent dehydration or fluid overload.

 Maintain normal serum potassium and sodium

blood levels.

 Maintain acceptable phosphate and calcium

level.
Protein
• For adults 1g/kg weight provides nutritional
needs, maintain positive nitrogen balance and
replaces amino acids lost during dialysis
treatment. 75 percent of daily protein
allowance should be protein of high biological
value such as eggs, meat , fish and poultry.
Milk is restricted at it has a high content of
sodium, phosphate and potassium.
Energy
• Carbohydrates are given to be supply energy
and prevent protein breakdown. The usual
need is 40 kcal/kg lean body weight. Simple
carbohydrate goods should be given.
Water balance
• Fluid is limited to 400 to 500 ml/day plus an
amount equal to urinary output.
Sodium
• To control body fluid retention and
hypertension , sodium is limited to 1000 to
2000 mg/ day.
Potassium
• Potassium accumulation can cause cardiac
arrest and hence potassium restriction is
necessary. A dietary allowance of 1500 to 2000
mg/day is given.