Prevention of urinary Prevention of urinary organs disease organs disease

Lecturer:Lecturer:

Nykytyuk S.O.Nykytyuk S.O.

Prevention of urinary organs disease

Plan of the lecture Plan of the lecture

Definition of pyelonephritisDefinition of pyelonephritis PyelonephritisPyelonephritis classification classification Clinical manifestationClinical manifestation Methods of examinations Methods of examinations Treatment of the different kinds of Treatment of the different kinds of

pyelonephritispyelonephritis

PyelonephritisPyelonephritis

Is an infectious inflammatory Is an infectious inflammatory disease of tubulointerstitial renal disease of tubulointerstitial renal tissuetissue

E coliE coli is the most common by far, is the most common by far, causing 75-90% of UTIs.causing 75-90% of UTIs.

KlebsiellaKlebsiella species species ProteusProteus species species EnterococcusEnterococcus species species Staphylococcus saprophyticusStaphylococcus saprophyticus

EtiologyEtiology Hospital patients:Hospital patients:

– Escherichia coliEscherichia coli: 40%: 40%– Coagulase-negative staphylococci: 3%Coagulase-negative staphylococci: 3%– 'Other' Gram-negative bacteria: 25%'Other' Gram-negative bacteria: 25%– 'Other' Gram-positive bacteria: 16%'Other' Gram-positive bacteria: 16%– Candida albicansCandida albicans: 5%: 5%– Proteus mirabilisProteus mirabilis: 11%: 11%

Community-acquired Urinary Community-acquired Urinary Tract Infections:Tract Infections:– Escherichia coliEscherichia coli: 80%: 80%– Coagulase-negative staphylococci: 7%Coagulase-negative staphylococci: 7%– 'Other' Gram-negative bacteria: 4%'Other' Gram-negative bacteria: 4%– 'Other' Gram-positive bacteria: 3%'Other' Gram-positive bacteria: 3%– Proteus mirabilisProteus mirabilis: 6% : 6%

Classification of Classification of pyelonephritispyelonephritis

Form Form – PrimaryPrimary– SecondarySecondary

ObstructiveObstructive DysembriogeneticDysembriogenetic dysmetabolicdysmetabolic

Course Course – AcuteAcute– ChronicChronic

Manifest recurrent formManifest recurrent form Latent formLatent form

Classification of Classification of pyelonephritispyelonephritis PeriodPeriod

– ActiveActive– Period of partial remissionPeriod of partial remission– Period of full clinical and laboratory Period of full clinical and laboratory

remissionremission Renal functionRenal function

– Without disorders of renal functionWithout disorders of renal function– With disorders of renal functionWith disorders of renal function– Chronic renal insufficiencyChronic renal insufficiency

Clinical ManifestationClinical Manifestation

ExtrarenalExtrarenal– Syndrome of intoxicationSyndrome of intoxication– Pain syndromePain syndrome– DisuriaDisuria

RenalRenal– LeukocyturiaLeukocyturia– Bacteriuria (colony count over 100 000/ml)Bacteriuria (colony count over 100 000/ml)– Mild proteinuria Mild proteinuria – Slight hematuriaSlight hematuria– TLC and ESR are highTLC and ESR are high– Decreasing of total diuresis Decreasing of total diuresis – Decreasing of specific gravityDecreasing of specific gravity

Clinical ManifestationClinical Manifestation

Preschoolers and Preschoolers and schoolchildrenschoolchildren

Vomiting, diarrhea, abdominal painVomiting, diarrhea, abdominal pain FeverFever Strong-smelling urine, enuresis, Strong-smelling urine, enuresis,

dysuria, urgency, frequency, flank dysuria, urgency, frequency, flank pain or new enuresispain or new enuresis

Clinical Manifestation Clinical Manifestation NeonatesNeonates JaundiceJaundice Hypothermia or feverHypothermia or fever Failure to thriveFailure to thrive Poor feedingPoor feeding VomitingVomiting

InfantsInfants Poor feedingPoor feeding FeverFever Vomiting, diarrheaVomiting, diarrhea Strong-smelling urineStrong-smelling urine

Physical: Physical:

Hypertension should raise suspicion of Hypertension should raise suspicion of hydronephrosis or renal parenchyma hydronephrosis or renal parenchyma disease.disease.

Costovertebral angle (CVA) tendernessCostovertebral angle (CVA) tenderness Abdominal tenderness or massAbdominal tenderness or mass Palpable bladderPalpable bladder Dribbling, poor stream, or straining to Dribbling, poor stream, or straining to

voidvoid Examine external genitalia for signs of Examine external genitalia for signs of

irritation, pinworms, vaginitis, trauma, irritation, pinworms, vaginitis, trauma, or sexual abuse.or sexual abuse.

Plan of examinationPlan of examination Fool blood count Fool blood count urinanalysis urinanalysis Nechepurenko’s testNechepurenko’s test Kakovsky-Addis testKakovsky-Addis test Ambyrze’s testAmbyrze’s test urine culture (more than 10,000 CFU from bladder) urine culture (more than 10,000 CFU from bladder) Zimnitskiy’s testZimnitskiy’s test Biochemical test of bloodBiochemical test of blood

– Serum level of electrolytesSerum level of electrolytes– total protein, albumin and globulin level total protein, albumin and globulin level – residual nitrogen, blood urea, creatinineresidual nitrogen, blood urea, creatinine

Creatinine clearance Creatinine clearance Ultrasonography of kidneys and urinary bladder.Ultrasonography of kidneys and urinary bladder. Excretory urography Excretory urography Nuclear cystographyNuclear cystography

Data of excreatory Data of excreatory urographyurography Acute pyelonephritisAcute pyelonephritis

– Kidney is enlargedKidney is enlarged– Hypotonia of the uretersHypotonia of the ureters

Chronic pyelonephritisChronic pyelonephritis– Asymmetry of the kidneysAsymmetry of the kidneys– Deformation of calyco-pelvic systemDeformation of calyco-pelvic system– Irregular excretion of contrast substance Irregular excretion of contrast substance

up to adynamia of calico-pelvic systemup to adynamia of calico-pelvic system chronic secondary pyelonephritischronic secondary pyelonephritis

– Obstruction of the urinary tractObstruction of the urinary tract– Congenital malformationsCongenital malformations– RefluxesRefluxes– Renal dysplasiaRenal dysplasia

double kidneydouble kidney

dystopiadystopia

dystopia and nephroptosis dystopia and nephroptosis

L- and L- and SS--like kidneyslike kidneys

Renal multicystosis Renal multicystosis polycystic polycystic

kidneykidney

Ultrasound examination of Ultrasound examination of an 18-mo-old boy with an 18-mo-old boy with autosomal dominant autosomal dominant polycystic kidney disease polycystic kidney disease

Treatment of Treatment of pyelonephritispyelonephritis

Complete bed rest for 3-4 days. Complete bed rest for 3-4 days. Diet N 5a (quantity of liquid is 1.5 times Diet N 5a (quantity of liquid is 1.5 times

more than age necessities. Fresh fruits more than age necessities. Fresh fruits and vegetables with diuretic properties and vegetables with diuretic properties are desirable, especially melons) are desirable, especially melons)

At exacerbation period it is necessary At exacerbation period it is necessary to give milk-vegetable food with to give milk-vegetable food with limitation of protein (1.5-2 g/kg) and limitation of protein (1.5-2 g/kg) and salt (2-3 g) than diet 5 asalt (2-3 g) than diet 5 a

Antibacterial treatment (for 8-10 days, Antibacterial treatment (for 8-10 days, two cycles)two cycles)

- - BENZYLPENICILLIN Na - 20.000-BENZYLPENICILLIN Na - 20.000-50.000 U/kg – 7-10 days50.000 U/kg – 7-10 days– amoxiclav 25-50 mg/kg, amoxiclav 25-50 mg/kg, – or cefotaxim 100-150 mg/kg, or cefotaxim 100-150 mg/kg, – or ceftriaxon 100 mg/kg, or ceftriaxon 100 mg/kg, – or ciprophloxacin 10-20 mg/kg per or ciprophloxacin 10-20 mg/kg per

day in 2 equal doses.day in 2 equal doses.– or macropen 30-50 mg/kgor macropen 30-50 mg/kg– Gentamicyn 4-7 mg/kg Gentamicyn 4-7 mg/kg

Uroseptics Uroseptics

Furadonin, furagin 5-8 mg/kg 4 Furadonin, furagin 5-8 mg/kg 4 times per daytimes per day

Nalidixic acid (negram, Nalidixic acid (negram, nevigramon) 50-60 mg/kg 4 times nevigramon) 50-60 mg/kg 4 times per dayper day

5-NOK, nitroxolin 8-10 mg/kg 4 5-NOK, nitroxolin 8-10 mg/kg 4 times per daytimes per day

Biseptol (sulfamethoxazole, Biseptol (sulfamethoxazole, trimetoprim 2 mg/kg) twice a daytrimetoprim 2 mg/kg) twice a day

Phytotherapy Phytotherapy

Canefron 10-40 dr. or dragee 3 Canefron 10-40 dr. or dragee 3 times/day times/day

Urolesan 10-40 dr. 3 times/day Urolesan 10-40 dr. 3 times/day

Definition of theDefinition of the gglomerulonephritislomerulonephritis Is an infectious allergic renal Is an infectious allergic renal

disease with primary lesions disease with primary lesions of glomeruli.of glomeruli.

immunologically mediated immunologically mediated inflammation of renal inflammation of renal glomerules accompanied by glomerules accompanied by hematuria, proteinuria and hematuria, proteinuria and azotemiaazotemia

EtiologyEtiology::

a) bacterial ( staphylococcal) a) bacterial ( staphylococcal) infection;infection;b) Viral ( hepatitis B, b) Viral ( hepatitis B, mmononucleosis);ononucleosis);c) Fungal ( histoplasmosis );c) Fungal ( histoplasmosis );d) Parasitic (toxoplasmosis)d) Parasitic (toxoplasmosis)

Classification of Classification of glomerulonephritisglomerulonephritis

acuteacute chronicchronic subacute (malignant) subacute (malignant)

glomerulonephritisglomerulonephritis

Classification of acute Classification of acute glomerulonephritis glomerulonephritis

FORM FORM – With nephritic syndromeWith nephritic syndrome– With nephrotic syndromeWith nephrotic syndrome– With isolated urinary syndromeWith isolated urinary syndrome– With nephrotic syndrome, hematuria and With nephrotic syndrome, hematuria and

hypertension hypertension Activity of renal processActivity of renal process

– Period of initial manifestationsPeriod of initial manifestations– Period of comprehensive manifestationsPeriod of comprehensive manifestations– Period of reverse developmentPeriod of reverse development– Transition to chronic glomerulonephritis Transition to chronic glomerulonephritis

Classification of acute Classification of acute glomerulonephritisglomerulonephritis Without disorders of renal Without disorders of renal

functionfunction With disorders of renal functionWith disorders of renal function Acute renal insurfficiencyAcute renal insurfficiency

nephritic syndromenephritic syndrome

edema, edema, arterial hypertension, arterial hypertension, urinary syndrome (proteinuria, urinary syndrome (proteinuria,

hematuria, casturia)hematuria, casturia)

nephrotic syndromenephrotic syndrome

massive edema massive edema significant proteinuria (more than significant proteinuria (more than

3 g/l)3 g/l) hypoproteinemiahypoproteinemia hypercholesterolemiahypercholesterolemia

Classification of Classification of chronic chronic glomerulonephritisglomerulonephritis FORM FORM

– Nephrotic formNephrotic form– Hematuric formHematuric form– Mixed formMixed form

Activity of renal processActivity of renal process– Period of exacerbationPeriod of exacerbation– Period of partial remissionPeriod of partial remission– Period of full clinical and laboratory Period of full clinical and laboratory

remissionremission Renal functionRenal function

– Without disorders of renal functionWithout disorders of renal function– With disorders of renal functionWith disorders of renal function– Chronic renal insurfficiencyChronic renal insurfficiency

Subacute (malignant) Subacute (malignant) glomerulonephritisglomerulonephritis

– Without disorders of renal functionWithout disorders of renal function– With disorders of renal functionWith disorders of renal function– Chronic renal insurfficiencyChronic renal insurfficiency

Clinical manifestationClinical manifestation

Extrarenal symptomsExtrarenal symptoms– edemaedema– arterial hypertensionarterial hypertension

renal symptomesrenal symptomes– oliguria and anuriaoliguria and anuria– hematuriahematuria– proteinuria (mild, moderate, significant)proteinuria (mild, moderate, significant)– leucocyturia (rare)leucocyturia (rare)– casts (cylinders): hyaline, epithelial, granular, waxy casts (cylinders): hyaline, epithelial, granular, waxy

metabolic syndromemetabolic syndrome– disorder of water-electrolyte metabolismdisorder of water-electrolyte metabolism– disorder of protein metabolismdisorder of protein metabolism– disorder of lipid metabolismdisorder of lipid metabolism

Clinical manifestation of Clinical manifestation of acute glomerulonephritis acute glomerulonephritis

Diagnosis can generally be established on the Diagnosis can generally be established on the basis of the following clinical and laboratory basis of the following clinical and laboratory criteria: criteria:

Acute onset; Acute onset; Edema; Edema; Hematuria with red blood cell casts in the Hematuria with red blood cell casts in the

sediment;sediment; Hypertension; Hypertension; Evidence of antecedent streptococcal Evidence of antecedent streptococcal

infection; infection; Lowered serum betaC globulin concentration;Lowered serum betaC globulin concentration; Spontaneous improvement in a few days or Spontaneous improvement in a few days or

weeks.weeks.

Plan of examinationPlan of examination Fool blood count Fool blood count urinanalysis urinanalysis Nechepurenko’s testNechepurenko’s test Kakovsky-Addis testKakovsky-Addis test Ambyrze’s testAmbyrze’s test urine cultureurine culture Zimnitskiy’s testZimnitskiy’s test Biochemical test of bloodBiochemical test of blood

– Serum level of electrolytesSerum level of electrolytes– total protein, albumin and globulin level total protein, albumin and globulin level – cholesterole cholesterole – residual nitrogen, blood urea, creatinineresidual nitrogen, blood urea, creatinine

Creatinine clearance Creatinine clearance Ultrasonography of kidneys and urinary bladder.Ultrasonography of kidneys and urinary bladder. Excretory urography Excretory urography

Creatinine clearanceCreatinine clearance

newborn 40-65 ml/min/1.73 m2newborn 40-65 ml/min/1.73 m2 1 yr and older 60-120 ml/min/1.73 1 yr and older 60-120 ml/min/1.73

m2m2

cholesterole – 3.6-6.2 mmol/lcholesterole – 3.6-6.2 mmol/l

residual nitrogen – 14.3-28.6 residual nitrogen – 14.3-28.6 mmol/lmmol/l

blood urea – 2.5-8.3 mmol/lblood urea – 2.5-8.3 mmol/l

creatinine – 0.035-0.1 mmol/lcreatinine – 0.035-0.1 mmol/l

Renal functional tests azotemiaazotemia elevation of serum creatinineelevation of serum creatinine,, serum serum

inorganic phosphateinorganic phosphate hyperkalemia hyperkalemia metabolic acidosismetabolic acidosis The total serum protein concentration The total serum protein concentration

is slightly decreasedis slightly decreased 40% of children has elevated serum 40% of children has elevated serum

lipidslipids the levels of serum IgG and IgM and C1 the levels of serum IgG and IgM and C1

is also increasedis also increased Anemia is common in the early phase Anemia is common in the early phase

of AGN.of AGN.

Treatment of acute Treatment of acute glomerulonephritis glomerulonephritis

Complete bed rest until the symptoms Complete bed rest until the symptoms subside. subside.

Diet N 7a (Restriction of proteins, low Diet N 7a (Restriction of proteins, low quantity of fats & carbohydrates, water, salt, quantity of fats & carbohydrates, water, salt, allergenic foods)allergenic foods)

salt salt – at the 4-5 week 0.5 g/dayat the 4-5 week 0.5 g/day– at the 8 week 1.5 g/dayat the 8 week 1.5 g/day– for nest 2 yrs 50 mg/kg for nest 2 yrs 50 mg/kg

proteins (in case renal failure)proteins (in case renal failure)– at the first 1-4 days - 0.5-1g/kgat the first 1-4 days - 0.5-1g/kg– 5-7 days – 1-1.5 g/kg5-7 days – 1-1.5 g/kg– 7-10 days – 2.5 g/kg7-10 days – 2.5 g/kgliquidliquid15 ml/kg (400 ml/m2)15 ml/kg (400 ml/m2)

Treatment of acute Treatment of acute glomerulonephritisglomerulonephritis

Antibacterial treatment (for 8-10 days, two Antibacterial treatment (for 8-10 days, two cycles)cycles)

- - BENZYLPENICILLIN Na - 20.000-50.000 BENZYLPENICILLIN Na - 20.000-50.000 U/kg – 7-10 daysU/kg – 7-10 days– amoxiclav 25-50 mg/kg, amoxiclav 25-50 mg/kg, – or cefotaxim 100-150 mg/kg, or cefotaxim 100-150 mg/kg, – or ceftriaxon 100 mg/kg, or ceftriaxon 100 mg/kg, – or ciprophloxacin 10-20 mg/kg per day in 2 or ciprophloxacin 10-20 mg/kg per day in 2

equal doses.equal doses.– or macropen 30-50 mg/kgor macropen 30-50 mg/kg

treatment of chronic locus of infectiontreatment of chronic locus of infection

Treatment of acute Treatment of acute glomerulonephritisglomerulonephritis membranostabilizers membranostabilizers

– tocoferol acetatis tocoferol acetatis Improvement of renal flowImprovement of renal flow

– electrophoresis with nicotinic acid or electrophoresis with nicotinic acid or heparinheparin

– i/v injections of i/v injections of euphyllin 2 mg/kg 3 times per day euphyllin 2 mg/kg 3 times per day trental 5 mg/kg 3 times per day (amp. 5 trental 5 mg/kg 3 times per day (amp. 5

ml 2 % sol., dragee 100mg) or dipiridamol ml 2 % sol., dragee 100mg) or dipiridamol 5 mg/kg 3 times per day per os5 mg/kg 3 times per day per os

Vitamin therapy Vitamin therapy

Treatment of acute Treatment of acute glomerulonephritisglomerulonephritis Management of edemaManagement of edema

– lasix 1-2 mg/kg i/mlasix 1-2 mg/kg i/m– hypothiazid 0.5-1 mg/kg per os hypothiazid 0.5-1 mg/kg per os

Management of hypertension and Management of hypertension and eclampsia eclampsia – renin-angiotensin-aldosteron system renin-angiotensin-aldosteron system

antagonistsantagonists captopril, cozaar, analapril 0.25-0.5 mg/kgcaptopril, cozaar, analapril 0.25-0.5 mg/kg in crisis: 0.1 ml/kg of 1% papaverini + 0.1 in crisis: 0.1 ml/kg of 1% papaverini + 0.1

ml/kg of 0.5 % dibazoli ml/kg of 0.5 % dibazoli

Treatment of subacute Treatment of subacute glomerulonephritisglomerulonephritis

1.1. Corticosteroids 2-3 mg/kg/day + Corticosteroids 2-3 mg/kg/day + cyclophosphamide 4-5 mg/kg/day or cyclophosphamide 4-5 mg/kg/day or cyclosporin A 5-10 mg/kg/daycyclosporin A 5-10 mg/kg/day

2.2. trental 5 mg/kg 3 times per day or trental 5 mg/kg 3 times per day or dipiridamol 5 mg/kg 3 times per day per dipiridamol 5 mg/kg 3 times per day per osos

3.3. heparin (fraxiparin) 500 IU/kg/dayheparin (fraxiparin) 500 IU/kg/day4.4. PlasmapheresisPlasmapheresis

pulse-therapy pulse-therapy Corticosteroids 20-25 mg/kg/day i/v for 3-6 Corticosteroids 20-25 mg/kg/day i/v for 3-6

timestimes

Nutrition and Chronic Kidney Disease

When you have chronic kidney disease, diet is an importantWhen you have chronic kidney disease, diet is an important part of your treatment plan. Your recommended diet maypart of your treatment plan. Your recommended diet may change over time if your kidney disease gets worse. A numberchange over time if your kidney disease gets worse. A number of tests should be done to "keep tabs on" your overallof tests should be done to "keep tabs on" your overall nutritional health. Your doctor can also refer you to a registerednutritional health. Your doctor can also refer you to a registered dietitian who will help you plan your meals to get thedietitian who will help you plan your meals to get the right foods in the right amounts. This booklet will tell youright foods in the right amounts. This booklet will tell you about some things that are important to your diet including:about some things that are important to your diet including: ❖ ❖ getting the right amount of getting the right amount of calories and proteincalories and protein ❖ ❖ staying at a healthy staying at a healthy body weightbody weight ❖ ❖ other important nutrients in your dietother important nutrients in your diet — — sodiumsodium — — phosphorusphosphorus — — calciumcalcium — — potassiumpotassium — — fluidsfluids — — vitamins and mineralsvitamins and minerals ❖ ❖ handling handling special diet needsspecial diet needs — — diabetesdiabetes — — vegetarian dietsvegetarian diets ❖ ❖ how your nutritional health is checkedhow your nutritional health is checked ❖ ❖ other resources that can help you.other resources that can help you.

The information is based on The information is based on recommendationsrecommendations

developed by the National Kidney developed by the National Kidney Foundation’s Kidney Disease Foundation’s Kidney Disease Outcomes Quality Initiative to Outcomes Quality Initiative to help your doctorhelp your doctor

provide the best care for you. provide the best care for you.

Your Changing Diet

As a patient with chronic kidney disease, your recommendedAs a patient with chronic kidney disease, your recommended diet may change over time, depending on how much kidneydiet may change over time, depending on how much kidney function you have. Your glomerular filtration rate, or GFR, isfunction you have. Your glomerular filtration rate, or GFR, is the best way to track your level of kidney function. Your doctorthe best way to track your level of kidney function. Your doctor can estimate your GFR from the results of a simple bloodcan estimate your GFR from the results of a simple blood test for creatinine along with your age, sex and body size. Iftest for creatinine along with your age, sex and body size. If your kidney disease progresses, and your GFR continues toyour kidney disease progresses, and your GFR continues to decrease, the amount of protein, calories and other nutrientsdecrease, the amount of protein, calories and other nutrients in your diet will be adjusted to meet your changing needs. Ifin your diet will be adjusted to meet your changing needs. If dialysis or a kidney transplant is needed eventually, your dietdialysis or a kidney transplant is needed eventually, your diet will be based on the treatment option you choose. Your doctorwill be based on the treatment option you choose. Your doctor can refer you to a registered dietitian who will explain thecan refer you to a registered dietitian who will explain the changes you need to make in your diet and help you choosechanges you need to make in your diet and help you choose the right foods.the right foods. 55

Getting the Right Amount of Calories

Getting enough calories is important to Getting enough calories is important to your overall healthyour overall health

and well-being. Calories are found in and well-being. Calories are found in all the foods you eat.all the foods you eat.

They are important because they:They are important because they: ❖ ❖ give your body give your body energyenergy ❖ ❖ help you stay at a help you stay at a healthy weighthealthy weight ❖ ❖ help your body use protein for help your body use protein for

building muscles and tissues.building muscles and tissues.

Because your recommended diet may limit protein, you mayBecause your recommended diet may limit protein, you may also be cutting down on an important source of calories. Asalso be cutting down on an important source of calories. As a result, you may need to get extra calories from other foods.a result, you may need to get extra calories from other foods. Your doctor can refer you to a registered dietitian who willYour doctor can refer you to a registered dietitian who will help you plan your meals to get the right amount of calorieshelp you plan your meals to get the right amount of calories each day. Your dietitian may recommend using more simpleeach day. Your dietitian may recommend using more simple carbohydrates like sugar, jam, jelly, hard candy, honey andcarbohydrates like sugar, jam, jelly, hard candy, honey and syrup. Other good sources of calories come from fats such assyrup. Other good sources of calories come from fats such as soft (tub) margarine, and oils like canola or olive oil, whichsoft (tub) margarine, and oils like canola or olive oil, which are low in saturated fat and have no cholesterol. You shouldare low in saturated fat and have no cholesterol. You should talk with your dietitian about the best way to get the righttalk with your dietitian about the best way to get the right amount of calories and keep your blood sugar in control ifamount of calories and keep your blood sugar in control if you have diabetes.you have diabetes.

Maintaining a healthy weight is also Maintaining a healthy weight is also important.important.

People who have chronic kidney People who have chronic kidney disease often need to gain weight ordisease often need to gain weight or

remain at their current weight. If you remain at their current weight. If you need to lose weight, your dietitian will need to lose weight, your dietitian will teach you how to lose the weight teach you how to lose the weight slowly and carefully without risking slowly and carefully without risking your health.your health.

Steps to Take

❖ ❖ Ask your doctor about a Ask your doctor about a referral to a registered dietitianreferral to a registered dietitian who specializes in diets for kidney patients.who specializes in diets for kidney patients. ❖ ❖ Ask your dietitian to Ask your dietitian to help you plan meals help you plan meals with the rightwith the right amount of calories.amount of calories. ❖ ❖ Keep a Keep a diary diary of what you eat each day. Show this to yourof what you eat each day. Show this to your dietitian on a regular basis.dietitian on a regular basis. ❖ ❖ Ask your doctor and dietitian what your Ask your doctor and dietitian what your ideal body weightideal body weight should be, and weigh yourself each day in the morning.should be, and weigh yourself each day in the morning. ❖ ❖ If you are If you are losing too much body weight, losing too much body weight, ask your dietitianask your dietitian how to add extra calories to your diet.how to add extra calories to your diet. ❖ ❖ If you are slowly If you are slowly gaining too much weight, gaining too much weight, ask your dietitianask your dietitian for suggestions on how to safely reduce your dailyfor suggestions on how to safely reduce your daily calorie intake and increase your activity level.calorie intake and increase your activity level. ❖ ❖ If you If you gain weight rapidly, gain weight rapidly, speak to your doctor. A suddenspeak to your doctor. A sudden increase in weight, along with swelling, shortness ofincrease in weight, along with swelling, shortness of breath and a rise in your blood pressure may be a sign thatbreath and a rise in your blood pressure may be a sign that you have too much fluid in your body.you have too much fluid in your body.

Getting the Right Amount of Protein

Getting the right amount of protein is important to yourGetting the right amount of protein is important to your overall health and how well you feel. Your body needs theoverall health and how well you feel. Your body needs the right amount of protein for:right amount of protein for: ❖ ❖ building musclesbuilding muscles ❖ ❖ repairing tissuerepairing tissue ❖ ❖ fighting infections.fighting infections. Your doctor may recommend that you follow a diet that hasYour doctor may recommend that you follow a diet that has controlled amounts of protein. This may help decrease thecontrolled amounts of protein. This may help decrease the amount of wastes in your blood and may help your kidneys toamount of wastes in your blood and may help your kidneys to work longer.work longer. Protein comes from two sources. You will need to get someProtein comes from two sources. You will need to get some protein each day from both of these sources:protein each day from both of these sources: ❖ ❖ Animal sources, Animal sources, such as eggs, fish, chicken, red meats, milksuch as eggs, fish, chicken, red meats, milk products and cheese.products and cheese. ❖ ❖ Plant sources, Plant sources, such as vegetables and grainssuch as vegetables and grains

Steps to Take

❖ ❖ Ask your dietitian how much protein you need to eatAsk your dietitian how much protein you need to eat each day.each day. ❖ ❖ Show your daily food diary to your dietitian, and ask ifShow your daily food diary to your dietitian, and ask if you are eating the right amount of protein.you are eating the right amount of protein. Working With Your DietitianWorking With Your Dietitian You may feel a bit confused by all the new informationYou may feel a bit confused by all the new information about your kidney disease and its treatment. You probablyabout your kidney disease and its treatment. You probably have many questions about your diet. Help is available tohave many questions about your diet. Help is available to you. Your doctor can refer you to a registered dietitian withyou. Your doctor can refer you to a registered dietitian with special training in kidney disease. This dietitian can answerspecial training in kidney disease. This dietitian can answer your questions about your diet and can help you plan youryour questions about your diet and can help you plan your meals to get the right foods in the right amounts.meals to get the right foods in the right amounts. 88

Other Important Nutrients in Your Diet

To feel your best each day, you may need to change theTo feel your best each day, you may need to change the amounts of some of the following nutrients in your diet.amounts of some of the following nutrients in your diet. Your dietitian will help you plan your meals to get the rightYour dietitian will help you plan your meals to get the right amounts of each.amounts of each. ❖ ❖ SodiumSodium Kidney disease, high blood pressure and sodium are oftenKidney disease, high blood pressure and sodium are often related. Therefore, related. Therefore, you may need to limit the amount ofyou may need to limit the amount of sodium in your diet. sodium in your diet. Your doctor will let you know if youYour doctor will let you know if you need to cut back on sodium. If you do, your dietitian canneed to cut back on sodium. If you do, your dietitian can teach you how to select foods that are lower in sodium.teach you how to select foods that are lower in sodium. Learn to read food labels so you can make lower sodiumLearn to read food labels so you can make lower sodium choices when you shop for foods. Sodium is a mineral foundchoices when you shop for foods. Sodium is a mineral found naturally in foods. naturally in foods.

It is found in large amounts in table saltIt is found in large amounts in table salt and in foods that have added and in foods that have added table salt table salt such as:such as: ❖ ❖ salty seasonings like soy sauce, teriyaki sauce and salty seasonings like soy sauce, teriyaki sauce and

garlicgarlic or onion saltor onion salt ❖ ❖ most canned foods and some frozen foodsmost canned foods and some frozen foods ❖ ❖ processed meats like ham, bacon, sausage and cold processed meats like ham, bacon, sausage and cold

cutscuts ❖ ❖ salted snack foods like chips and crackerssalted snack foods like chips and crackers ❖ ❖ most restaurant and take-out foodsmost restaurant and take-out foods ❖ ❖ canned or dehydrated soups (like packaged noodle canned or dehydrated soups (like packaged noodle

soup).soup).

You may need to limit the use of You may need to limit the use of salt salt substitutes that are highsubstitutes that are high

in potassium. in potassium. Speak to your doctor Speak to your doctor and dietitian about this.and dietitian about this.

TIP: TIP: Try fresh or dried herbs and spices Try fresh or dried herbs and spices instead ofinstead of

table salt to enhance the flavor of table salt to enhance the flavor of foods. Also,foods. Also,

try adding a dash of hot pepper sauce try adding a dash of hot pepper sauce or aor a

squeeze of lemon juice for flavor.squeeze of lemon juice for flavor.

Phosphorus

❖ ❖ Your kidneys may not be able to remove enough phosphorusYour kidneys may not be able to remove enough phosphorus from your blood. This causes the level of phosphorus in yourfrom your blood. This causes the level of phosphorus in your blood to become too high. A high blood phosphorus levelblood to become too high. A high blood phosphorus level may cause you to itch and lose calcium from your bones. Yourmay cause you to itch and lose calcium from your bones. Your bones can become weak and may break easily. bones can become weak and may break easily. Eating fewerEating fewer foods that are high in phosphorus foods that are high in phosphorus will help lower the will help lower the

phosphorusphosphorus in your blood. Your dietitian will help you choosein your blood. Your dietitian will help you choose foods that are lower in phosphorus.foods that are lower in phosphorus. Phosphorus is found in large amounts in the following:Phosphorus is found in large amounts in the following: ❖ ❖ dairy products such as milk, cheese, pudding, yogurt,dairy products such as milk, cheese, pudding, yogurt, ice cream and puddingice cream and pudding ❖ ❖ dried beans and peas such as kidney beans,dried beans and peas such as kidney beans, split peas and lentilssplit peas and lentils ❖ ❖ nuts and peanut butternuts and peanut butter ❖ ❖ beverages such as cocoa, beer and dark cola drinksbeverages such as cocoa, beer and dark cola drinks

Your doctor may also prescribe a type Your doctor may also prescribe a type of medication called aof medication called a

phosphate binder phosphate binder for you to take for you to take with all your meals andwith all your meals and

snacks.snacks. TIP: TIP: Using non-dairy creamers and Using non-dairy creamers and

recommended milkrecommended milk substitutes in place of milk is a good substitutes in place of milk is a good

way to lowerway to lower the amount of phosphorus in your diet.the amount of phosphorus in your diet.

Calcium

Calcium is a Calcium is a mineral mineral that is important for building that is important for building strongstrong bones. bones. However, foods that are good sources of calcium areHowever, foods that are good sources of calcium are also high in phosphorus. To keep your calcium and also high in phosphorus. To keep your calcium and

phosphorusphosphorus in balance and prevent loss of calcium from your bones,in balance and prevent loss of calcium from your bones, you may need to follow a diet that limits phosphorus-richyou may need to follow a diet that limits phosphorus-rich foods and take phosphate binders. Your doctor may also askfoods and take phosphate binders. Your doctor may also ask you to take you to take calcium supplements and a special calcium supplements and a special

prescriptionprescription form of vitamin Dform of vitamin D. Take only the supplements or . Take only the supplements or

medicationsmedications recommended by your doctor.recommended by your doctor. 1010

Potassium

Potassium is an important mineral in the blood that Potassium is an important mineral in the blood that helpshelps your muscles and heart your muscles and heart work properly. work properly. Too much or too Too much or too

littlelittle potassium in the blood can be dangerouspotassium in the blood can be dangerous. Whether or . Whether or

notnot you need to change the amount of high-potassium foods inyou need to change the amount of high-potassium foods in your diet depends on your your diet depends on your stage of kidney disease stage of kidney disease andand whether you are taking any whether you are taking any medications that change themedications that change the level of potassium in your blood. level of potassium in your blood. (For more information (For more information

onon the stages of chronic kidney disease, see the table on thethe stages of chronic kidney disease, see the table on the inside front cover. You may also contact the NKF to obtaininside front cover. You may also contact the NKF to obtain

About Chronic Kidney Disease: A Guide for Patients and theirA Guide for Patients and their FamiliesFamilies.) Ask your doctor if your potassium .) Ask your doctor if your potassium

level is normal.level is normal. Your doctor may ask you to take potassium Your doctor may ask you to take potassium

supplements orsupplements or other medications to balance the amount of other medications to balance the amount of

potassium inpotassium in your blood. Take only the supplements your blood. Take only the supplements

recommended by yourrecommended by your doctor. Your dietitian can help you plan a diet doctor. Your dietitian can help you plan a diet

that will givethat will give you the right amount of potassium from your you the right amount of potassium from your

food.food.

Fluid

In general, you In general, you do not need to limit the do not need to limit the amount of fluids youamount of fluids you

drink in the earlier stages of kidney drink in the earlier stages of kidney disease. disease. (If you don’t(If you don’t

know your stage, ask your doctor and contact know your stage, ask your doctor and contact the NKF forthe NKF for

additional information.) If your kidney additional information.) If your kidney disease gets worse,disease gets worse,

your doctor will let you know when you need your doctor will let you know when you need to limit fluidsto limit fluids

and how much fluid is okay for you each day.and how much fluid is okay for you each day. ❖❖

Vitamins and Minerals

Vitamins and minerals come from a variety of foods Vitamins and minerals come from a variety of foods you eatyou eat

each day. If your diet is limited, you may need to take each day. If your diet is limited, you may need to take specialspecial

vitamins or minerals. vitamins or minerals. Take only the vitamins and Take only the vitamins and mineralsminerals

your doctor recommends for you. your doctor recommends for you. Certain vitamins Certain vitamins and mineralsand minerals

may be harmful to people with chronic kidney disease.may be harmful to people with chronic kidney disease. Also check with your doctor before taking any herbal Also check with your doctor before taking any herbal

reme dies as some of these may also be harmful to reme dies as some of these may also be harmful to people withpeople with

kidney disease. kidney disease.

Cooking with herbs is a safe choice, and canCooking with herbs is a safe choice, and can often be used instead of salt to flavor foods. Check with youroften be used instead of salt to flavor foods. Check with your doctor and dietitian about the right vitamins and mineralsdoctor and dietitian about the right vitamins and minerals for you.for you. Steps to TakeSteps to Take ❖ ❖ Ask your doctor and dietitian which nutrients you need toAsk your doctor and dietitian which nutrients you need to limit in your diet.limit in your diet. ❖ ❖ Ask your dietitian for help in planning your meals to getAsk your dietitian for help in planning your meals to get the right amount of each nutrient in your daily diet.the right amount of each nutrient in your daily diet. ❖ ❖ Learn to read food labels so you can make lower sodiumLearn to read food labels so you can make lower sodium choices when you shop for foods.choices when you shop for foods. ❖ ❖ Ask your dietitian for tips about flavoring your foods withAsk your dietitian for tips about flavoring your foods with herbs and spices in place of table salt.herbs and spices in place of table salt. ❖ ❖ Take only those supplements, medications, vitamins andTake only those supplements, medications, vitamins and minerals recommended by your doctor.minerals recommended by your doctor.

Some Tips to Help With Your Diet

❖ ❖ Non-dairy creamers can be used in place of milk inNon-dairy creamers can be used in place of milk in cereals, coffee and many sauces.cereals, coffee and many sauces. ❖ ❖ Labels on food packages only give you informationLabels on food packages only give you information about some of the nutrients in your diet. Read labelsabout some of the nutrients in your diet. Read labels and ask your dietitian for more information.and ask your dietitian for more information. ❖ ❖ Herbs, spices, table wine and special vinegar can beHerbs, spices, table wine and special vinegar can be used instead of salt to make your food flavorful. Tryused instead of salt to make your food flavorful. Try purchasing or growing fresh herbs. Ask your dietitianpurchasing or growing fresh herbs. Ask your dietitian for a list of herbs and spices that blend with differentfor a list of herbs and spices that blend with different types of foods.types of foods.

Handling Special Diet Needs

❖ ❖ Diabetes and Your Special DietDiabetes and Your Special Diet You may need to make You may need to make only a few changes only a few changes in your in your

diabeticdiabetic diet to fit your needs as a kidney patient. If your diet to fit your needs as a kidney patient. If your

doctor suggestsdoctor suggests that you eat less protein, your diet may need to that you eat less protein, your diet may need to

includeinclude more carbohydrates or high-quality fats to give you more carbohydrates or high-quality fats to give you

enoughenough calories. Work with your dietitian to design a meal calories. Work with your dietitian to design a meal

plan especiallyplan especially for you. Check your blood sugar levels often, and for you. Check your blood sugar levels often, and

contactcontact your doctor if your levels are too high or too low.your doctor if your levels are too high or too low.

Vegetarian Diets (Plant-based diets)

❖ ❖ Most vegetarian diets are not rich in protein. Most vegetarian diets are not rich in protein. Eating Eating enoughenough

calories calories is an important way to use these smaller is an important way to use these smaller amounts ofamounts of

protein for important jobs like building muscle, healingprotein for important jobs like building muscle, healing wounds and fighting infection. Talk with your dietitian wounds and fighting infection. Talk with your dietitian

aboutabout the best choices of vegetable protein with lower the best choices of vegetable protein with lower

amounts ofamounts of potassium potassium and and phosphorus. phosphorus. Also, monitor your Also, monitor your

blood proteinblood protein (albumin) levels closely with your dietitian to make (albumin) levels closely with your dietitian to make

sure yousure you are getting the right amount of protein and calories.are getting the right amount of protein and calories.

How Your Nutritional Health is CheckedHow Your Nutritional Health is Checked There are several different ways for your doctor and dietitianThere are several different ways for your doctor and dietitian to know if you are eating the right amount of calories or protein.to know if you are eating the right amount of calories or protein. This section will explain these tests and methods. If yourThis section will explain these tests and methods. If your kidney disease gets worse, and/or your nutritional healthkidney disease gets worse, and/or your nutritional health changes, you may need to have these tests more often. Askchanges, you may need to have these tests more often. Ask your doctor and dietitian about your test results. If youryour doctor and dietitian about your test results. If your results are not as good as they should be, ask how to improveresults are not as good as they should be, ask how to improve them. You may also want to track your important test resultsthem. You may also want to track your important test results by using the Dialysis Lab Log, available by calling the Nationalby using the Dialysis Lab Log, available by calling the National Kidney Foundation’s toll-free number (800) 622-9010.Kidney Foundation’s toll-free number (800) 622-9010.

Lab Tests for Protein Balance

Serum AlbuminSerum Albumin Albumin is a type of protein found in your blood. YourAlbumin is a type of protein found in your blood. Your albumin level will be checked by a blood test. If your levelalbumin level will be checked by a blood test. If your level is too low, it may mean you are not eating enough proteinis too low, it may mean you are not eating enough protein and/or calories. If your albumin continues to be low, youand/or calories. If your albumin continues to be low, you have a greater chance of getting an infection, being have a greater chance of getting an infection, being

hospitalizedhospitalized and generally not feeling well.and generally not feeling well. nPNA (normalized protein nitrogen appearance)nPNA (normalized protein nitrogen appearance) This is another way to find out if you are not eating theThis is another way to find out if you are not eating the right amount of protein. The nPNA result comes from labright amount of protein. The nPNA result comes from lab studies that include a urine collection and blood work.studies that include a urine collection and blood work. Your nPNA helps to check the protein balance in yourYour nPNA helps to check the protein balance in your body.body. 1616

Physical Nutrition Exam

Your dietitian may use a method called Your dietitian may use a method called Subjective GlobalSubjective Global Assessment (SGA) Assessment (SGA) to check your body for signs of nutritionto check your body for signs of nutrition problems. This involves asking you some questionsproblems. This involves asking you some questions about your food intake and looking at the fat and muscleabout your food intake and looking at the fat and muscle stores in your body. The dietitian will consider:stores in your body. The dietitian will consider: — — changes in your weightchanges in your weight — — changes in the tissues around your face, arms,changes in the tissues around your face, arms, hands, shoulders and legshands, shoulders and legs — — your food intakeyour food intake — — your activity and energy levelsyour activity and energy levels — — problems that might interfere with eating.problems that might interfere with eating. Steps to TakeSteps to Take ❖ ❖ Ask your doctor and dietitian which tests will be used toAsk your doctor and dietitian which tests will be used to check your nutritional health.check your nutritional health. ❖ ❖ Track your own test results using the Lab Log. Discuss yourTrack your own test results using the Lab Log. Discuss your results with your doctor and dietitian.results with your doctor and dietitian.