Dietary management Nephritis

Dr. Capt. Sandhya Rani Mohanty

 KIDNEY & FUNCTIONS OF KIDNEY

The kidneys are very important organ in the body which is

responsible for getting rid of waste products, drugs and
toxins through urine.

The kidneys excrete waste products of the body in general,

and the end products of protein metabolism in particular.

Kidneys diseases means kidneys are damaged and can’t filter

as well.

Hypertension and Diabetes are the major causative

factors for kidney failure.
At the onset of acute kidney disease, the urine output
is markedly diminished.

Urea and the other end products of protein metabolism are

retained.

The formation of these waste products can be considerably

diminished by restricting the intake of dietary proteins and
diminishing the breakdown of tissue proteins by supplying
protein sparers like carbohydrates and fats.
Each kidney has approximately
one million nephrons which filter
water and other substances out of
the blood to produce urine.
 FUNCTIONS OF KIDNEYS

1. As excretory organs, kidneys remove waste

products of nitrogen metabolism. Urea, uric
acid and creatinine are excreted.

2. Kidneys regulate the amount of water,

sodium and hydrogen ions in the body.

3. Kidneys are exclusive site for the production

of 1, 25, dihydroxy cholecalciferol, the active
form of vitamin D.
 FUNCTIONS OF KIDNEYS
4. Know the causes, symptoms and dietary

management of glomerulonephritis.
5. Understand the causes, management and
prevention of kidney stones.

6. Kidneys also produce erythropoietin, which

is essential for the synthesis of RBC.
7.Renin is released from the kidneys in

response to low BP directly and also

stimulates the production of aldosterone.
8.Parathyroid hormones, calcitonin, insulin
and gastrin are degraded by the kidneys.
 TYPES OF KIDNEY DISEASES

The following are the types of kidney diseases:

Glomerulonephritis:
This is an inflammation of the glomeruli.
Glomerulonephritis can be caused by infections, drugs or congenital
abnormalities.

Kidney stones:
Kidney stones are another common kidney problem. Passing kidney
stones can be extremely painful, but they rarely cause significant
problems.

Chronic kidney disease:

The most common form of kidney disease is chronic kidney disease. Chronic
kidney disease is a longterm condition that doesn’t improve over time. It is
commonly caused by high blood pressure. Diabetes is also a major cause of
chronic kidney disease.
 Polycystic kidney disease: Polycystic
kidney disease is a genetic disorder that causes numerous cysts (small
sacs of fluid) to grow in the kidneys. These cysts can interfere with kidney
function and cause kidney failure.

Urinary tract infections: Urinary tract

infections (UTIs) are bacterial infections of any part of the urinary system.
Infections

Glomerular Filtration Rate (GFR)

 Glomerular Filtration Rate (GFR)
•GRF is a test used to check how well the
kidneys are working.
•Specifically, it estimates how much blood
passes through each unit of glomeruli.
•A GFR of 60 or higher is in the normal range.
• A GFR of 15 or lower may mean kidney
failure.

•In the bladder and urethra are the most

common.
•They are easily treatable and rarely lead to

more health problems.

•However, if left untreated, these infections
can spread to the kidneys and cause kidney
failure.
NEPHRITIS /GLOMERULO NEPHRITIS

Nephritis is a condition in which the nephrons, the functional

units of the kidneys, become inflamed.
This inflammation, which is also known as glomerulonephritis,
can adversely affect kidney function.
 It is most common in its acute form in children 3 to
10 years of age although it can also occur in adults
past age 50

Causes
• Streptococcal infection.
• Renal infarction,
• Acute pyelonephritis
• Metallic poisoning

• primary kidney diseases such as

• IgA nephropathy and hereditary nephritis
•Secondary nephritis can occur due to systematic lupus
erythromatous (SLE).
Blood Urea Nitrogen (BUN)
•BUN can provide important information about the kidney
function.
•The test measures the amount of urea nitrogen in the blood.
•In general, around 7-20 mg/dl is considered as normal.
•High level BUN is a sign that the kidneys are not working.
Symptoms
• Haematuria (blood in the urine)
• Proteinuria (protein the urine)
• Oedema (fluid retention)
• Shortness of breath
• Tachycardia (increased heartbeat)
• Elevated blood pressure
• Anorexia
• Oliguria (low excretion of urine) /anuria
(no excretion of urine)
• Uraemia (increased serum urea)
 Dietary management
Objectives

• Reduce elevated serum nitrogen levels from

breakdown of exogenous or endogenous proteins.
• Reduce elevated blood pressure or oedema.
• Spare protein for tissue repair.
• Improve renal functioning.
• In children, avoid growth retardation over time.
The dietary management provides optimal
nutrition support.
Adequate proteins should be given, unless
there is oliguria or anuria.
Salt is restricted if there is oedema,
hypertension or oliguria.
 Energy
1. 80kcal/ kg body weight and 10 percent for infection
is suggested.
2. Sufficient calories are given without increasing the protein
intake by means of sugar, honey, glucose, sago and other
starchy foods like arrowroot.

Above mentioned foods are not only rich in calories

but also poor in protein, sodium and potassium.
 Protein
•Usually the diet contains 0.5 grams of protein/kg of ideal body
weight.
•The intake of protein is reduced to a minimum by excluding protein
rich foods.
•A low protein diet is recommended so as to give rest to the kidneys.
•Complete proteins like milk, fish, etc are better to ensure maximum
utilization.
•Second quality proteins like pulses are restricted.
•Rice is preferable as it has low amount of protein but better quality of
protein than wheat.
 Fluids:

•Daily fluid replacement should be 500ml plus

daily amount excreted in urine.

•The fluid is calculated taking into account the

water consumed with drugs, water present in
milk, curds, buttermilk, tea, coffee, fruit juice
and water used in sambhar and rasam.
 Sodium
The sodium is restricted to 500 to 1000mg/day. In sodium
restricted diets, the following foods are avoided:

•Salt during cooking or on the table.

• Baked products containing baking soda and sodium
bicarbonate.
• Papads
• Pickles
• Salted chips
• Salted nuts
•Foods where sodium salts are used as a preservative
like squashes and sauces.
• Dried fruits
• Dried fish.
Sodium Rich Foods
Potassium:
• Potassium is found naturally in almost all foods
particularly in fruits, vegetables and meats.
• Potassium content can be reduced in vegetables by
cooking in excess water and then discarding the water.
This is called leeching.

• Spices and condiments can be used in small

quantities as they are rich in potassium.
The following foods which are high in potassium are
restricted in a patient suffering from glomerulonephritis
Potassium rich foods
 Potassium rich foods

• Nuts
• Jaggery
• Instant coff ee
• Chocolate
• Cocoa powder
• Amaranth
• Spinach
• Colocasia
• Yam
• Mango
• Sweet lime
• Amla
• Lemon
Phosphorus:

Eating foods high in phosphorus will raise the phosphorus in

blood and this can cause calcium to be pulled from bones.
This will make bones weak and cause them to break easily.

The following foods which are rich in phosphorus should be

restricted in the diet:

• Milk • Mango
•Cheese • Amla
•Nuts • Lemon
•Bakery products • Eggs
• Pulses
Phosphorus
 Foods permitted and avoided in glomerulonephritis
Foods permitted Foods avoided
•Rice •Pulses
• Milk or milk products, not • Soups
more than 300-
•Meat,
400 ml
• Vegetables, cooked in large • Fish
amount of water with excess of • Fruits rich in potassium
water that is drained out •Dried fruits
• Potato, sweet potato or yam •Nuts
• Sugar •Condiments and spices
• Sago •Papads and pickles
• Gourd vegetables
 Free Foods

When proteins, sodium and potassium are

restricted it is difficult to obtain sufficient energy.
Foods low in protein, sodium & potassium but
provide energy can be given.
These include sugar, lollipop, sago, boiled sweets,
sugar candy unsalted butter, unsalted margarine,
dalda, oil and ghee.
 A Day’s Sample Menu for Nephritis patient

Do not forget to drink 4 glasses of water in between meals daily