ACUTE RENAL FAILURE

It occurs when your kidneys due to some defect suddenly become unable to filter the wastes
present in your blood.When these harmful wastes accumulate in your body, the chemical
balance of blood gets disturbed.It develops rapidly over few hours or few days.
Symptoms: Decreased urine output, shortness of breath, fluid retention, nausea, fatigue,
confusion
Causes: Conditions that cause less blood flow to kidneys, direct damage to kidneys, blockage
of ureters leading to low urine output
Risk factors: Hospitalization,diabetes,hypertension,cardiac diseases,age,stress,liverdiseases,
blockages etc.
Complications: Fluid buildup, chest pain, muscle weakness.

CHRONIC RENAL FAILURE (Early stage)

It is termed as the gradual loss in the kidney function.Its signs and symptoms do not become
apparent until the function has been lost significantly.
Symptoms: Nausea, vomiting, loss of appetite, changes in urine output, swelling of feet and
ankle, muscle weakness, shortness of breath.
Causes: Recurrent kidney infection, diabetes, hypertension, glomerulonephritis, prolonged
urinary tract blockage, polysistic kidney disease.
Risk factors: Diabetes, blood pressure, smoking, obesity, high cholesterol.
Complications: Causes damage to heart and blood vessels, pregnancy and fetal
complications,fluid retention,swelling, anemia, decreased immune response and brain
function.

NUTRITIONAL THERAPY
Goals:
 To maintain fluid, electrolyte and mineral balances.
 To prevent or correct conditions as: Uremia,hyperlipidemia,protein calorie malnutrition,
pulmonary complications.
 To put less burden on kidneys.
Dietary modifications:
Energy: Increased energy is needed in case of acute or chronic renal failure. Energy demand
further varies according to age,gender and other conditions.30-40 k cal//kg boy weight energy
is recommended.
Carbohydrates: Increased intake is recommended.
Proteins: 0.5-0.6g per kg body weight protein is needed.Protein intake is decreased but is
increased gradually as GRF returns to normal.60% should be high biological value protein.
Fats: Moderate fat should be consumed.Mono and polyunsaturated sources should be
preferred.
Fluid: It is urine calculated on a daily basis by adding urine output+500ml on a daily basis.
Minerals: Na: 20-40 mEq /day, K: 30-50 mEq/day, P:Limit as needed.
Food choice tips:
Try to be active and eat a sensible diet.Lessen the K intake: Rich K sources are bananas,
oranges, spinach,tomato,sweet potatoes. Apple,cabbage,green beans,grapes and strawberries
can be taken.Limit the products with added salts, and processed meats and other natural
hidden sources of salt .Restrict it when edema is present.Limit phosphorus rich sources like
milk,cheese,dry beans etc.
Choose whole grain breads and cereals.As protein intake is limited to certain range avoid
high quantity protein sources like meat,egg,cheese etc.Can be taken in recommended
amounts above but should not exceed.Low protein sources include fruits, vegetables, cereals
etc.
DISORDERS OF RENAL DISEASE
Mr. Hashmi is 52 years of age who is suffering from nephrotic syndrome. His ideal body
weight is 80 kg and in the last 24 hours he has lost 9 gm protein in his urine (1.5 liter, 6 g per
liter). Calculate his protein, energy requirements and plan a day’s menu making use of the
food exchanges given in Table 9.1 of Unit 9.

Protein Requirements g

Energy Requirements g

High Biological value (HBV) protein g LBV protein g

LBV Exchanges / Substitutes Servings

Bread & Bread Products
Vegetable & Vegetable Products
Fruit & Fruit Products
Dal & Dal Products

HBV Protein Exchanges Servings

Milk & Milk Products
Meat & Meat Products
Egg & Egg Products

Total Protein = HBV Protein + LBV Protein

A Day’s Menu:

1. Breakfast Weight 3. Lunch Weight

2. Snacks Weight 4. Dinner Weight

5. Mid-Afternoon Weight
Snacks

6. Bed Time Weight

Snacks

Further Advice:

PRACTICAL ACTIVITY
 Plan a day’s diet for a patient with chronic renal failure (using local foods / dishes, whose
ideal weight is 70 kg. Analyze it in the light of model menu given in the following Box

A sample menu for patients with severe chronic renal failure

Such patients need a diet that is very low in protein, providing moderate energy.
The quantities of nutrients in this typical daily menu are approximately:
Protein of high biological value 18-20 g
Energy 2200 kcal
Fluids 500 ml
Sodium 12 mmol
Potassium 15 mmol
Breakfast
1 cup porridge made with oat meal, cooked with fat and water
1 slice (30 g) salt free, protein free bread (toasted)
Jam, jelly, marmalade, or honey
Tea with glucose
10 ml milk
Mid-Morning
Sherbet with glucose
Lunch
25 g chicken
30 g boiled rice
Salt-free butter or ghee
30 g very low- protein vegetables
30g very low protein fruit and cream
Tea
40 ml grapefruit juice and glucose
10 g salt free, protein free biscuit or rusk
Dinner
1 egg (scrambled)
1 slice (30 g) of bread with salt free butter
30 g low protein fruit
Plain ice cream
Bedtime
90 ml milk with glucose or sugar
10g salt-free, protein-free biscuit or rusk

Very low protein vegetables are tomatoes, egg-plant, pumpkin’s, carrots, onions, and
green beans. Very low protein fruits are pears, apples, pineapples, and grapefruit
The menu does not meet the patients requirements for the B vitamin, iron, and calcium,
and supplements of these should be given. Extra fluid , e.g. milk, or tea, or liquid glucose,
may be given depending on the patient’s urine output.
Phosphorus = 700 mg per day.
Protein 0.6 per kg ideal body weight (70% HBV)
Energy 35 Kcal (46kj) per kg ideal weight
Fluid unrestricted
Sodium – Normal

a) Diet Plan

Type of Quantity by Protein Phosphorus

Calories
Meal Measure / by wt. Grams mg

Breakfast:

Mid-Morning:

Lunch:

Mid-Afternoon:

Dinner:
 Total:

b) Comparison & Analysis

Tutor’s Comments: