Renal Disease
Kidney
functions
The nephrotic syndrome
Acute Renal Disease
Chronic Renal Failure
 Kidney Stones
Kidney Functions
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Regulate extracellular fluid volume and osmolarity
Regulate electrolyte concentrations
Regulate acid-base balance
Excrete metabolic waste products like urea and
creatinine and a number of drugs and toxins
Help to regulate blood pressure
Produce the hormone erythropoietin, which
stimulates the production of red blood cells in the
bone marrow
Convert vitamin D to its active form – plays a primary
role in calcium regulation and bone formation
The Nephrotic Syndrome: Treatment
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Protein and energy
– Helps minimize losses of muscle tissue
– High-protein diets not advised – can exacerbate urinary
protein losses
– 0.8 – 1.0 grams of protein per kilogram of body
weight/day
– 35 kcalories/kilogram body weight daily – sustains
weight and spares protein
– Weight loss or infections–signal the need for additional
kcalories
The Nephrotic Syndrome: Treatment
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Fat
– A diet low in saturated fat, cholesterol, and
refined sugars helps to control elevated blood
lipids
– May need lipid-lowering medications prescribed
per physician
The Nephrotic Syndrome: Treatment
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Sodium
– Sodium restriction helps to control edema
– Suggested to limit intake to < 2-3 grams
daily
– If diuretics prescribed for edema –
potassium wasting may occur
– Encouraged to select foods rich in
potassium
The Nephrotic Syndrome: Treatment
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Vitamins and minerals
– May require vitamin D and calcium
supplementation – prevent bone loss and rickets
– Multivitamin supplements – prevent additional
nutrient deficiencies
Acute Renal Disease: Consequences
Kidneys become unable to regulate the levels of
 electrolytes, acid, and nitrogenous wastes in in
blood.
 Urine may be diminished in quantity or absent.
 Diagnosis – often a complex task.
 Fluid and electrolyte imbalances
Acute Renal Disease
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Goals of nutritional therapy for ARF patients:
debilitated:
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Minimize uremia (accum. of bld nitrogenwaste
“urea”) and maintain the body’s regular chemical
composition
Preserve the body’s protein stores
Maintain fluid, electrolyte, and acid-base
homeostasis
Nutritional therapy for ARF patients
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Protein –
Due to catobolic condition associated with
hypermetabolism and muscle wasting – sufficient protein
and energy needed to preserve body’s protein content
 0.6g/kg/day in non-dialyzed, non-hypercatabolic patient.
 With dialysis – protein restricted to 1.2 – 1.3
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Calories –
35 kcal/kg of BW/day .
Nutritional therapy for ARF patients
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Fluids.
– Needed to monitor weight fluctuations, blood pressure,
pulse rates, appearance of skin and mucous
membranes
– Daily fluid intake should equal urine output, plus
approximately 500ml to replace insensible losses
( the water lost through skin, lungs and perspiration)
– Individuals with fever, vomiting, or diarrhea requires
additional fluid
– If on dialysis more liberal fluid intake allowed –1.5-2
liters/day
Nutritional therapy for ARF patients
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Vitamins/Minerals –
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Electrolytes must be closely monitored. Potassium and
phosphate levels may be elevated. There may also be salt
and water imbalances.
With oliguria (abnl production of urine) – sodium intakes
limited to 2-3 grams daily
If on dialysis-generally can consume electrolytes more freely
Oliguric patients who experience diuresis may need
electrolyte replacement to compensate for urinary losses
Some patients need enteral or parenteral nutrition support
to obtain adequate energy (high Kcal Low ptn and
electrolytes)
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Chronic Renal Failure: Consequences
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Generally progresses over many years without
causing symptoms
Typically diagnosed late in the course of illness, after
most kidney function has been lost
Most common causes :
• Diabetes mellitus (43%)
• Hypertension (26%)
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Altered electrolytes and hormones
Uremic syndrome
Chronic Renal Failure
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Goals of nutritional therapy.
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Prevent symptoms of uremia while restoring
biochemical balance.
Retard progression of the disease.
Provide adequate calories to maintain or achieve
ideal body weight.
Nutritional therapy for chronic renal
failure
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Protein –
Protein should be restricted to 0.6g/kg/day, with
sufficient essential amino acids.
 Once dialysis begun – protein restrictions relaxed
• Dialysis removes nitrogenous wastes
• Some amino acids –lost during the procedure.
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Calories –
Calorie intake should be about 35 kcal/kg to maintain
body weight.
 Foods and beverages of high nutrient density
 Malnourished patients may require oral formulas or
tube feedings to maintain weight
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Nutritional therapy for chronic renal
failure
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Fat –
 Restrict saturated fat and cholesterol levels, some renal
patients at risk for coronary heart.
 Renal diets include high-fat foods to increase calories –
encourage patients to select foods providing mostly
monounsaturated fats.
Nutritional therapy for chronic renal
failure
 Fluids
and Sodium –
 Fluid intake should be based on the patient’s ability to eliminate
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fluid
Fluid intake should match the daily urine output,if urine output
decreases Fluids – should be restricted
Excrete less urine as CRF progresses – can’t handle normal
sodium and fluid intake
Monitor total urine output, changes in body weight and blood
pressure and serum sodium levels
2-3 gm/d.adeq., but 1gm/d if the renal failure is severe.
Once on dialysis – sodium and fluid intakes controlled so that
water weight gain is 2 pounds between dialysis treatments
Nutritional therapy for chronic renal
failure
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Potassium –
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Calcium and Phosphate –
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2 to 3 gms/day should be initiated.
supplement calcium and restrict phosphate to 8-12
mg/kg/day.
Vitamins and Mineral
Supplementing folic acid, B6, B-complex, Vitamin D, Vitamin
C necessary. Vitamin A and E not recommended because it
may accumulate with renal failure.
Kidney Transplants
Immunosuppressive Drug Therapy
– Side effects of nausea, vomiting, diarrhea, glucose
intolerance, altered blood lipids, fluid retention,
hypertension and infection
– Increases risk of food borne infection – food safety
guidelines discussed with patients and caregivers
 – Dietary interventions
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Kidney Transplants
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Energy: 30-35kcal/kg/d. adjust to maintain reasonable weight.
Protein: 1.3-1.5 g/kg/d ,reduced to 1g/kg/d after 6-8 weeks
Carbohydrate: consistent CHO intake/d. increase fiber.
Fat: Limited saturated fat and cholesterol to help control serum
lipids.
Sodium: Restricted (to 2-4g/d ) if fluid retention and hypertension
are present.
Potassium: adjust according to serum potassium levels.
Calcium: 1000 to 1500 mg to minimize bone loss associated with
drug therapy.
Phosphorus: 1200-1500 mg: supplement needed if serum
phosphorus is low.
Fluid: No restriction
Kidney Stones
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Kidney stone – crystalline mass that forms within the urinary
tract . Stone passage can cause severe pain or block the urinary
tract.
Formation of kidney stones- 75% of kidney stones – made up
primarily of calcium oxalate
Factors that predispose to stone formation:
• Dehydration or low urine volume
• Renal disease
• Urine acidity
• Metabolic factors
• Calcium oxalate stones
• Uric acid stones
• Cystine stones
• Struvite stones (could be initiated by bacteria forming from
ph)
Kidney Stones: Consequences
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Consequences of kidney stones
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Renal colic
Urinary tract complications
Kidney Stones: Prevention and
treatment of kidney stones
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– Diet containing 800 – 1000 mg of calcium
per day is recommended because calcium
combines with oxalate in the intestines,
reducing its absorption and helping to control
hyperoxaluria
– Moderate protein and sodium restriction
advised
High fluid intakes recommended
hemodialysis
peritoneal dialysis
Thank you!