INTRODUCTION

•     All of us have two kidneys, each the size of a clenched fist, positioned in the back     of the body behind the lower ribs.

•     It is an organ of excretion, conversion, secretion, reabsorption, manufacture and     regulation.

•      A healthy kidney is basically a filtering system made up millions of filtering units called nephrons.

FUNCTIONS OF KIDNEYS

•     Filtration to remove toxins

•     Regulation of total body water content

•     Maintainence of blood pressure by controlling the levels of water and salts     (sodium and potassium) in the body.

•     Synthesis of active vitamin D, to give strength to our bones.

•     Formation of Red blood cells (components of blood) in the body.

•     Urine is acidic, thus maintaining the blood alkaline.

WHAT IS RENAL DISEASE ?
A disease characterized by the kidney’s inability to excrete waste products, maintain fluid and electrolyte balance and produce hormones.

DISEASES OF KIDNEY

•     Nephritis :

•     Type I  -  There is accumulation of fluid, electrolytes, urea and other waste retained in the blood and tissue.

•     Type II  -  There is no retention of urea and other nitrogenous waste products.

•     Acute Renal Failure  
  •  Sudden loss of functioning of nephrons, accumulation of urea and other waste products.

•     Chronic Renal Failure

•    It is also known as uraemia - elevated level of urea in the blood.

WHY IS DIETARY TREATMENT SO IMPORTANT ?

•     To minimize the accumulation of waste products in the body.

•     To maintain normal levels of blood pressure.

•     To prevent or reverse malnutrition.

•     To prevent further damage to the kidneys.

DIETARY MODIFICATION IN RENAL FAILURE

•     FLUIDS        -     Urine output + 500 ml.

•     ENERGY    -    30 - 35 Kcal/Kg. Body weight

•     PROTEIN    -    0.8 - 1 gm/Kg. Body weight

•     SODIUM    -    2 - 3 gm/day

•     POTASSIUM    -    3 - 4 gm/day

FLUIDS

•     The amount of fluids allowed usually depends on the urinary output and the body’s need.

•     Fluid intake urinary output should be carefully recorded.

•     The fluid calculated taking into the account the water consumed with drugs, water present in milk, curds, buttermilk, tea, coffee, fruit juice and water used in dals, curries.

TIPS ON FLUID CONTROL

•     Drink only when you are thirsty and not of habit.

•     Avoid salty, high sugar & fried foods as these can increase thirst.

•     Take your medication with meal - time liquids and not extra water.

•     Keep a record of what you are drinking.

•     Drink from a small cup or a glass.

ENERGY

•     It comes from 3 major food sources :    
  • Carbohydrates 
  • Proteins    
  • Fats

•     The energy requirements of every patient varies according to :

•     Age, Sex, Physical activity, Height, Weight,

•     Clinical and Pathological conditions.

PROTEINS

•     Body Building Food

•     Maintain healthy body tissues

•     Replace cells that are lost each day

QUALITY OF PROTEINS

High Biological Value	Low Biological Value
Milk and Milk Products	Cereal and its Products
Meat, Fish & Poultry	Dals and Pulses
Egg	Nuts and Oil seeds
Soya and Soya Products	Vegetables like peas and beans.

• Be cautious about the amount and type of protein as their end product accumulate in the body in kidney diseases.

• Eat 50% of your proteins from High Biological value sources and distribute them well in the Diet.

SODIUM

•     It is a mineral.

•     Is present in body water

•     Found in almost all foods

•     Normally excreted by kidney (in kidney failure, sodium is retained and excess sodium causes fluid retention).

•     Sodium can increase blood pressure.

TIPS FOR REDUCING SODIUM INTAKE.

•     Avoid processed foods like canned foods, ready mixes, processed cheese.

•     Avoid pickles, Chutney, Papads, Ketchups

•     Avoid frequent use of convenience foods like noodles, macroni, Pasta.

•     Avoid dry fish, cured or smoked meat, salami’s, Sausages and kababs.

•     Use salts discretely by restricting the menu variety, not adding salt in foods such as chappatis, rice, salads, soups and like.

•     Make use of flavours as, onions flakes, vinegar, tamarind pulp, garlic - ginger - green chillies.

•     Prepare meals without using aji-no-motto, baking soda, Eno powder. Meals could be pressure cooked. Make use of sour curds for leavening, chilled water to retain color.

•     Choose to grill, steam, prepare gravy in lean portions of white meat. Do not consume organ meats. Fresh river water fish (es) are preferred  to sea foods.

POTASSIUM

•     Is a mineral

•     Excess potassium is dangerous - Cause heart to stop without warning.

•     Too little is harmful

•     Potassium levels  are  monitored 2/3 monthly.

TIPS TO REDUCE POTASSIUM INTAKE

•     Take low potassium fruits & vegetables.

•     Take one cup of Tea / Coffee per day

•     Avoid coconuts, chocolates, cocoa and Aerated Drinks.

•     Use the wheat flour with bran for chapatis.

•     Increase menu variety by leaching vegetable (Double boil & discard its water)

•     Prepare pulses and legumes in gravy (helps restricting its quantity).

•     Judiciously include condiments & spices to improve palatability.

•     Use fresh cow’s  milk & its products while preparing curd, kheer, etc.   

FIBER

•     Fiber in diet is important in order to maintain good daily bowel movements.

•     High fiber foods include bran, fresh fruits (with skin) and fresh green / root vegetables, grains.

IN SUMMARY - YOUR MEAL PLAN

•     Eat a variety

•     Eat at regular meal times

•     Avoid foods that contain a lot of fat, salty foods and simple sugars.

•     Eat more foods with fiber and complex carbohydrates.

•     Eat the right amount for your energy needs.

•     Eat the right diet as per your Nutritionist advise.