diet for kidney disease
Nephrotic therapy for syndrome nutritional focuses on

Nephrotic therapy for syndrome nutritional focuses on

Objective: To discuss the nutritional treatment of patients with nephrotic syndrome. Methods: Nutritional therapy and health education were performed in patients with nephrotic syndrome. Conclusion: Supplement nutrition, correct "three high and one low", use high energy high bio - high protein diet, limit intake of sodium, control fat and cholesterol.


Objective: To discuss the nutritional treatment of patients with nephrotic syndrome. Methods: Nutritional therapy and health education were performed in patients with nephrotic syndrome. Conclusion: Supplement nutrition, correct "three high and one low", use high energy high bio - high protein diet, limit intake of sodium, control fat and cholesterol.

The main clinical features of nephrotic syndrome are proteinuria, severe edema, plasma albumin is too low and blood cholesterol is too high. There are severe proteinuria, every day from the urine of the protein in more than 10g of any kidney disease, can occur nephrotic syndrome. The following analysis of nutritional treatment of patients with nephrotic syndrome reported as follows.

Clinical symptoms of nephrotic syndrome

1.hypoproteinemia nephrotic syndrome, patients with significant low plasma albuminemia, is due to increased glomerular permeability from the urine to discharge a large number of protein, 24h urine protein often more than 3.5g, up to 20g or more , Lost protein to albumin-based. Serum total protein decreased, albumin reduction is more obvious, globulin normal or slightly increased. Low plasma albuminemia diagnostic criteria for plasma albumin concentration < 30g / L, due to long-term large number of albumin lost from the urine, albumin can be> 3g / d. Vascular intracellular albumin pool catabolism significantly increased; loss of appetite lead to exogenous protein intake not enough; protein synthesis and metabolism decreased, such as liver dysfunction and so on. Plasma protein reduction is very different, and urine protein, protein intake of protein, liver protein synthesis and other hormone metabolism and so on.

2.water and sodium retention of nephrotic syndrome, due to impaired renal function, glomerular filtration rate decreased, sodium and water retention, or kidney on the ANF lack of response, decreased secretion of sodium, resulting in blood volume expansion, increased capillary hydrostatic pressure ; Hypoproteinemia caused by plasma colloid osmotic pressure decreased, water retention in the tissue gap. Blood volume reduction, through the baroreceptors, so that increased renin activity, aldosterone and antidiuretic hormone secretion increased, renal tubular sodium and water reabsorption increased, and water and sodium retention edema. Plasma extravasation causes edema. Therefore, the majority of water and sodium retention is caused by the kidney itself, rather than reduced plasma capacity.

3.hyperlipidemia: Most patients with nephrotic syndrome abnormal lipid metabolism. Hypoproteinemia, can promote intrahepatic synthesis of protein, lipoprotein and cholesterol, serum cholesterol can be as high as 7.77mmol / L or more. Unsaturated fatty acids into the liver, fat and muscle intake of fatty acids reduced, causing serum triglycerides and cholesterol increased. Protein nitrogen and urea nitrogen and other metabolites normal, significantly lower blood circulation can be increased, decreased urine output. Combined with hyperlipidemia in patients with atherosclerosis is due to lipid-loaded macrophages, continuous deposition to the blood vessel wall formed.

Nephrotic therapy for syndrome nutritional focuses on

4.minerals and trace elements metabolism. Trace elements such as iron, calcium, copper, zinc and other elements in patients with nephrotic syndrome,vitamin D3 and other vitamin metabolism has changed, the main reason is related to the loss of transporter proteins from urine. Nephrotic syndrome, blood iron concentration decreased, causing iron deficiency anemia, but not common in clinical, mainly with the transfer of iron from the urine increased and increased degradation related. Blood free calcium and total body calcium are reduced. The occurrence of low vitamin D3 blood, not due to renal tissue synthesis of vitamin D3 due to decline, because in patients with normal renal function also exist low vitamin D3 blood.

Nutritional therapy for Nephrotic syndrome

Supplement the nutrition to correct the "three high and one low", the use of high-energy high bio-high protein diet and limit the intake of sodium to control fat and cholesterol.

  • 1 high protein diet: The traditional view that a large number of proteinuria caused by blood protein concentration, especially albumin concentration decreased plasma colloid osmotic pressure decreased, edema stubbornly difficult to eliminate. Such as renal function is good, given high protein diet, according to 1.5 ~ 2g / kg per day, the total amount of 100 ~ 120g / d. But the diet protein increases, can stimulate the liver synthesis of albumin, but also cause changes in glomerular hemodynamics and glomerular filtration membrane permeability increased, so that albumin loss increased; also caused by renal tissue albumin Increased catabolism. Therefore, the high protein diet does not improve the serum protein concentration in patients, on the contrary will make the clear protein concentration to further reduce and damage the renal function. To give low-protein diet can inhibit the amino acid oxidation, inhibition of protein decomposition to maintain positive nitrogen balance, and high protein diet no difference. Strictly limit the amount of dietary protein, while adding essential amino acids or α-keto acid, the same can maintain positive nitrogen balance, reduce urinary protein excretion, improve serum albumin concentration, improve renal function.

    When the supply of high protein, high bio-protein protein accounted for 60% to 70% of the total. Nitrogen retention should limit the intake of protein, can be supplemented on the basis of low-protein diet, the whole day about 50g.

  • 2 Supply of sufficient energy: energy 0.13 ~ 0.15MJ (30 ~ 35kcal) / kg per day, the total amount of 8.37 ~ 10.46MJ (2000 ~ 2500kcal). Patients often have poor appetite. Therefore, the food variety should be diversified, the color flavor is good, delicious, to increase appetite.

  • 3 limit sodium according to edema may be, usually intake of sodium 1000 ~ 2000mg / d; severe should be limited to 500mg / d. Note that fasting sodium food, such as soy sauce tofu, pickles, salted eggs, pineapple eggs, salt no more than 2g / d, or soy sauce 10ml. Fasting with alkali staple food and high sodium vegetables, such as white radish, spinach, cabbage, rape and so on. If diuretics, edema slightly back to the appropriate relaxation of sodium intake.

  • 4 fat amount of fat supply a total of 50 ~ 70g / d, accounting for 20% of the total energy. Most patients with elevated blood lipids, and even fasting can also achieve the degree of milky. Although all the blood lipid can be involved, but the increase in neutral fat up, especially in cholesterol. Persistent low-fat diet, and can not reduce blood lipids; due to excessive blood lipids secondary to plasma albumin decreased, repeated infusion of albumin, plasma albumin increased. When the edema disappears, the proportion of plasma cholesterol and phospholipids decreases. Plasma triglycerides and lipoproteins at the same time decreased, plasma turbidity decreased.

  • 5 full amount of vitamins and minerals: selected rich in iron and B vitamins, vitamin A and vitamin C food. Long-term large amounts of proteinuria, calcium and phosphorus deficiency, leading to osteoporosis, hypocalcemia, it must pay attention to calcium supplement.

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