INTRODUCTION: CASE: A patient with a height 53 has the case of Acute Glumerolunephritis, with slight edema, decreased urine

output, and elevated blood urea nitrogen. ACUTE GLUMEROLUNEPRHITIS An active inflammation in the glomeruli. Each kidney is composed of about 1 million microscopic filtering "screens" known as glomeruli that selectively remove uremic waste products. The inflammatory process usually begins with an infection or injury (e.g., burn, trauma), then the protective immune system fights off the infection, scar tissue forms, and the process is complete. DIET: A person with acute glomerulonephritis may need to avoid some foods and limit the amount of others. Waste products that failing kidneys cannot handle include protein, sodium, potassium, and phosphorus. General Dietary Restrictions When the kidneys are not working normally, waste products (blood urea nitrogen), the result of what we eat, build up in the bloodstream. Kidney dialysis (kidney machine) removes part of these byproducts temporarily until, once again, they accumulate. It is important for both the patient who is dependent upon dialysis, or suffering from compromised kidney function, to follow a carefully outlined diet. Typical dietary restrictions will be placed on total calories, fluids, protein, sodium, phosphorus, and potassium. Supplemental calcium is also required by many patients. Calories Calories are a measurement of the energy value of food. They are an essential part of any diet. The number of calories you eat affects your ability to gain and lose weight. An inadequate number of calories will burn protein derived not only from the protein that you eat, but also from the body's own muscle stores. A healthy diet must give your body both the required amount of protein for tissue growth and repair, as well as enough calories for your energy needs. Excess calories and protein will put an unnecessary strain on a diseased kidney. Fluids When the kidneys are no longer functioning efficiently, fluids accumulate in the body. Fluid overload can contribute to shortness of breath, hypertension, and swelling of the hands, legs, and feet. This condition can lead to congestive heart failure and excess build up of fluid in the lungs. Fluids are defined as all liquids, including all foods that melt to a liquid at room temperature. Since fluid overload is dangerous, it is important to limit your intake. Keeping track of your weight every day can allow you to early detect any trend of fluid retention. Sodium The balance of fluid in the human body is partly regulated by the mineral sodium. When sodium is combined with chloride, it forms table salt. Excessive amounts of salt in the diet result in the retention of too much water. This may cause a sudden increase in weight, swelling of the tissues and joints, high blood pressure, shortness of breath, and congestive heart failure. Most foods contain sodium either naturally or as additives. High sodium foods include processed and smoked meats, foods with salt toppings such as chips or nuts, sauces, and prepared and canned foods. Many kidney disease patients must limit their sodium intake to 2 grams per day or less.

Potassium The mineral potassium plays a key role in the normal functioning of the muscles and nerves as well as in regulating the pumping action of the heart. Muscle weakness and cardiac arrhythmias may be the result of high levels of

potassium in the blood. Since the heart is a muscle, a buildup of potassium may lead to sudden death (cardiac arrest). Potassium is found in almost all foods and in salt substitutes. Your potassium level should be monitored closely. A dangerously high blood potassium level in a patient with end-stage kidney disease is a criterion for emergent kidney dialysis. Protein Protein is restricted to decrease the kidney's workload while the kidneys heal and slow the buildup of waste in the blood. Select high-quality proteins such as lean meats, fish, chicken and eggs. Most calories will need to be supplied by complex carbohydrates such as whole wheat pasta, brown rice, whole grain breads and cereals, fruits and vegetables. Calories from fats should be supplied by monounsaturated fat sources such as peanut butter, avocados and olive oil and polyunsaturated fat sources such as salmon, soybeans and fish oil. Calcium and Phosphorus The balance of calcium and phosphorus in the body is crucial to the maintenance of healthy bones, muscles, and nerves. Renal disease contributes to the imbalance of these important minerals. Too much phosphorus may cause the bones to become brittle and break easily. This results from the body's removal of calcium in the bones to balance the excess phosphorus. Foods high in phosphorus are usually also high in potassium (another mineral that must be restricted). Phosphorus rich foods are dairy products, meats, shellfish, bran, whole grain products, beans, nuts, and chocolate. Calcium is found in most dairy products, but will need to be supplemented (OS-CAL) in most cases. Vitamins and Minerals Vitamin and mineral supplements such as (OS-CAL) are frequently needed since dietary restrictions may prevent a renal patient from receiving all the needed nutrients necessary for a healthy and balanced diet. Kidney dialysis can also remove vitamins from the bloodstream. Vitamin supplements should only be prescribed by a physician in patients with kidney disease.

SOURCES: http://www.nephrologychannel.com/agn/index.shtml http://www.freemd.com/acute-glomerulonephritis/home-care-kidney-diet.htm http://www.ehow.com/way_5475451_acute-glomerulonephritis-diet.html http://emedicine.medscape.com/article/777272-overview http://www.nephrologychannel.com/agn/index.shtml http://www.ehow.com/way_5475451_acute-glomerulonephritis-diet.html

DIETARY COMPUTATION: DBW:KG = ht(cm)-100 = 160 cm 100 = 60 kg TER: sedentary = 30 cal times 50 kg = 1800 kcal

PERCENT OF DISTRIBUTE: CHO: 1,800(.65) = 1,170/ 4 = 295 g CHON: 1,800 (.15)= 270/4 = 70 g FAT: 1, 800 (.20)= 360/90 = 40 g FOOD EXCHANGE TABLE LIST VEGTABLE 1 VEGTABLE 2 FRUITS MILK SUGAR EXCHANGE CHO CHON 3 8 10 FAT S KCAL 48 160 170 180 800

3 9 4 40 1 12 9 45 TEMPORARY SUM: 106 CHO: 8 184 295-106=189/23 290 CHON: 5 70-27=43/8 LF 4 MF 1 FATS: 40-20=20/5 4

16

32 8 67

4 6 20 40

164 86 180 1783 Total: 1783

DIETARY PRESCRIPTION VEGETABLE BREAKFAST SNACK 1 LUNCH SNACK 2 DINNER FRUITS 1 1 1 1 MEAT 1 1 SUGAR 3 2 1 2 1 RICE 2 1 3 1 1 MEAT 2 2 1 FAT

2 1

2 2

MENU: BREAKSFAST:

Strawberry : 1-1/4 cup Milk, powdered : 1/4 cup or 4 level tablespoons 1 yema: 51-1/4 cm Tocino(low fat): 1 Slice 114.5 cm Chicken egg: 1 piece Snack 1: Lakatan: 1 piece 93 cm Condensed milk: 2 tsp Ice cream regular: 1/3 cup

LUNCH: Apple: of 8 cm diameter String beans: cup cooked Hard candy: 1 piece 32.5 cm Rice: 1 Sap sap: 2 pieces 163 Chicharon: 53 SNACK 2: PULVORON: 42 1 cm Orange juice: 1/3 cup Kutsinta: 1piece 6 cm diameter 2 cm DINNER: RICE: CUP cooked CHICKEN WINGS: 1 medium Cauliflower: cup cooked Butter: 2 teaspoon

SAINT LOUIS UNIVERSITY SCHOOL OF NURSING S.Y. 2010-2011

DIET AND NUTRITION THERAPY LABORATORY

DIETARY MEAL PLAN

SUBMITTED TO: MRS. RACHELLE GAY PACIAL SUBMITTED BY: BRAGAS, JAMES WAL, MICHAEL BOCAUTO, GLEANERSAN BENAS, KIETH ANNE GARCIA, JONESEL