Kidney disease and diet therapyKidney disease and diet therapy

Prepared byPrepared byHananHanan G. Altawil G. Altawil

SupervisorSupervisor

D. Baker M.ZabutD. Baker M.Zabut

2008-2008- هـهـ 14291429م /م /

The Islamic University-GazaDeanery of Higher EducatioFaculty of ScienceDepartment of Life ScienceZoology

- االسالميـة - الجامعـة االسالميـة الجامعـةغـزةغـزة

الدراسـات الدراسـات عمـادة عمـادةالعليـا العليـا العلـوم العلـوم كليـة كليـة

العلـوم العلـوم ماجستير ماجستيرالحياتيـةالحياتيـة

حيوان حيوان علم علم

لكريم القران في لكريم الغذاء القران في الغذاء

ن-اك,م+ ”” ق+ ز- ر- ا م- ط-ي3ب-ات1 م1ن ك,ل,وا+ ن,وا+ آم- ال7ذ1ين- ا ي9ه-- أ ن-اك,م+ ي-ا ق+ ز- ر- ا م- ط-ي3ب-ات1 م1ن ك,ل,وا+ ن,وا+ آم- ال7ذ1ين- ا ي9ه-- أ ي-ا

“ ت-ع+ب,د,ون- 1ي7اه, إ ك,نت,م+ إ1ن ل1ل?ه1 + وا ك,ر, “ و-اش+ ت-ع+ب,د,ون- 1ي7اه, إ ك,نت,م+ إ1ن ل1ل?ه1 + وا ك,ر, البقرة(البقرة(172172))و-اش+فى القران في ذكر فى الغذاء القران في ذكر في 5252الغذاء في سورة ايهايه160160سورة

النباتية النباتية االغذية االغذيةالزيتون زيت كالزيتون النباتية االغذية من العيديد الزيتون ذكر زيت كالزيتون النباتية االغذية من العيديد ذكر

القمح الخضر الفواكه الرمان النبق التين الموز القمح النخيل الخضر الفواكه الرمان النبق التين الموز النخيلالحب البصل العدس الفوم القثاء الحب البقل البصل العدس الفوم القثاء البقل

الحيوانية الحيوانية االغذية االغذيةواالسماك االنعام كالحوم االيات من العديد في ايضا واالسماك ذكر االنعام كالحوم االيات من العديد في ايضا ذكرطبية فائدة من فيه وما النحل وعسل واللبن طبية والسلوى فائدة من فيه وما النحل وعسل واللبن والسلوى

عظيمة عظيمة

النبوية االحاديث في النبوية االغذية االحاديث في االغذية

النباتية االغذية من الثمرات و التمر ذكر المثال سبيل النباتية على االغذية من الثمرات و التمر ذكر المثال سبيل علىالتمر أهمية إلى منبها وسلم عليه الله عليه صلى التمر قال أهمية إلى منبها وسلم عليه الله عليه صلى قال

الغذائية الغذائية

" وأحمد" مسلم رواه أهله جياع فيه تمر ال " بيت وأحمد" مسلم رواه أهله جياع فيه تمر ال بيت االغذية من الجراد الطحال الكبد السمك اللبن االغذية اللحم من الجراد الطحال الكبد السمك اللبن اللحم

الحيوانيةالحيوانية : قال أنه وسلم عليه الله صلى النبي : عن قال أنه وسلم عليه الله صلى النبي عن

والكبد" : والجراد السمك ودمان ميتتان لنا والكبد" : أحلت والجراد السمك ودمان ميتتان لنا أحلت والطحال"والطحال"

امتصاص على يشجع حيث العظيمة وفوائدة النحل امتصاص عسل على يشجع حيث العظيمة وفوائدة النحل عسلالصوديوم امتصاص من تزيد أن بدون األمعاء من الصوديوم الماء امتصاص من تزيد أن بدون األمعاء من الماء

تناول في اإلسالم تناول هدى في اإلسالم هدىوالشراب والشراب الطعام الطعام

: وجل عز : فقال وجل عز تسرفوا،” فقال وال واشربوا تسرفوا،” وكلوا وال واشربوا وكلوا“ المسرفين يحب ال “إنه المسرفين يحب ال .3131 ) )إنه .األعراف( األعراف(

،الى الموجهة األدلة النبوية السنة في وردت الى، وقد الموجهة األدلة النبوية السنة في وردت وقدوسلم : عليه الله صلى وسلم : فقال عليه الله صلى آدم" فقال ابن مأل آدم" ما ابن مأل ما

آدم ابن بحسب ، بطنه من شر من آدم وعاء ابن بحسب ، بطنه من شر من وعاءفاعل بد ال كان فإن أوده، يقمن فاعل لقيمات بد ال كان فإن أوده، يقمن لقيمات

" لنفسه وثلث لشرابه وثلث لطعامه "فثلث لنفسه وثلث لشرابه وثلث لطعامه فثلث : وسلم عليه الله صلى : وقال وسلم عليه الله صلى في" وقال المسلم في" يأكل المسلم يأكل

أمعا سبعة في يأكل والكافر واحد، أمعا معي سبعة في يأكل والكافر واحد، ".".ءءمعي

Each kidney has approx. 1million nephons which are the“filtering units” of the kidney

EXCRETORY SYSTEM

Functions of the KidneyFunctions of the Kidney

Filters )cleanses( bloodFilters )cleanses( blood

--Helps to maintain fluid, electrolyte balance in the bodyHelps to maintain fluid, electrolyte balance in the body - - Helps to maintain acid-base balance in the bodyHelps to maintain acid-base balance in the body - - Eliminates metabolic wastesEliminates metabolic wastes

Help to regulate blood pressureHelp to regulate blood pressure Produces erythropoietin – stimulates red bloodProduces erythropoietin – stimulates red blood cell cell

productionproduction Converts the inactive form of vitamin D into theConverts the inactive form of vitamin D into the active active

formform

Filtration , Haemodynamic , EndocrineFiltration , Haemodynamic , Endocrine

Consequences of Kidney DiseaseConsequences of Kidney Disease

Increase in blood nitrogen levelsIncrease in blood nitrogen levels Increase in blood creatinine levelsIncrease in blood creatinine levels Elevated blood electrolyte levels and fluidElevated blood electrolyte levels and fluid

retentionretention Anemia – low hemoglobin & hematocritAnemia – low hemoglobin & hematocrit Low vitamin D levelsLow vitamin D levels low blood calcium low blood calcium levelslevels

elevated parathyroid hormoneelevated parathyroid hormone Loss of serum proteins – “leak outLoss of serum proteins – “leak out””through through

kidneyskidneys

The stages of kidney diseaseThe stages of kidney disease Kidney damage with normal or high GFRKidney damage with normal or high GFR 9090

cc/min/1.73m² cc/min/1.73m² Kidney damage with mild decreased GFRKidney damage with mild decreased GFR 60 60

– 89– 89 cc/min/1.73m² cc/min/1.73m² Moderately decreased GFR 30 – 59Moderately decreased GFR 30 – 59

cc/min/1.73m² cc/min/1.73m² Severely decreased GFR 15 – 29Severely decreased GFR 15 – 29

cc/min/1.73m² cc/min/1.73m² Kidney FailureKidney Failure Less than 15 cc/min/1.73m²Less than 15 cc/min/1.73m²

Types of Kidney DisordersTypes of Kidney Disorders

Nephrotic SyndromeNephrotic Syndrome Acute Renal FailureAcute Renal Failure Chronic Renal FailureChronic Renal Failure kidney stoneskidney stones

Nephrotic SyndromeNephrotic Syndrome Nephrotic Syndrome – occurs when theNephrotic Syndrome – occurs when the glomerular glomerular

capillaries malfunction and there is acapillaries malfunction and there is a loss of plasma loss of plasma proteins into the urineproteins into the urine

TreatmentTreatment: : Diet Order is High KcalorieDiet Order is High Kcalorie, , moderate protein, sodium, and fat-restrictedmoderate protein, sodium, and fat-restricted– – Energy -~35Energy -~35 kcals/kg body wtkcals/kg body wt – – Protein – Protein – ..,8 - 1,8 - 1 gm/kg body wtgm/kg body wt. . – – Fat -<30Fat -<30% % of total kcalsof total kcals – – Sodium -<2Sodium -<2 grams/dgrams/d – – Medications – may be needed to decrease cholesterol Medications – may be needed to decrease cholesterol

and triglycerides, and also to lower bloodand triglycerides, and also to lower blood pressurepressure

Acute Renal FailureAcute Renal Failure Acute Renal Failure – occurs when the nephrons suddenly Acute Renal Failure – occurs when the nephrons suddenly

losefunction and are unable to maintain homeostasislosefunction and are unable to maintain homeostasis Can develop when blood flow to the kidney suddenly declines Can develop when blood flow to the kidney suddenly declines

)Prerenal)Prerenal))– – Heart failureHeart failure – – ShockShock – – Severe blood loss after surgerySevere blood loss after surgery

Can develop due to an obstruction in the urinary tract )post-Can develop due to an obstruction in the urinary tract )post-renalrenal( (

Can also develop when there is kidney cell damage )intra-Can also develop when there is kidney cell damage )intra-renalrenal( (

–– InfectionsInfections –– ToxinsToxins – – DrugsDrugs

Treatment of Acute Renal FailureTreatment of Acute Renal Failure

Main goal is to treat the underlying cause inMain goal is to treat the underlying cause in order to prevent permanent or further damage tothe order to prevent permanent or further damage tothe kidneyskidneys

- - Blood transfusion, dialysis, drug therapy, diet therapyBlood transfusion, dialysis, drug therapy, diet therapy Diet TherapyDiet Therapy – – Energy –Energy – 45-3045-30 kcals/kg; more may be needed toprevent kcals/kg; more may be needed toprevent

further wasting and malnutritionfurther wasting and malnutrition – – Protein Protein --.,6-.,8.,6-.,8 g/kg )non-dialysis(, 1,2 -1,3 g/kgg/kg )non-dialysis(, 1,2 -1,3 g/kg )dialysis()dialysis(- - Fluids – measure urine output and add Fluids – measure urine output and add 500 ml of500 ml of extra water; may need more water if dehydratedextra water; may need more water if dehydrated – – Sodium – may need to restrict to 2 to 3 g/daySodium – may need to restrict to 2 to 3 g/day

Some signs of Chronic kidney Some signs of Chronic kidney failurefailure

Extreme tirednessExtreme tiredness Nausea and vomitingNausea and vomiting Shortness of breathShortness of breath Difficulty sleepingDifficulty sleeping Swelling in the hands, faceSwelling in the hands, face, , and feetand feet Loss of appetiteLoss of appetite ItchinessItchiness High blood pressureHigh blood pressure

Some causes of kidney failureSome causes of kidney failure

GlomerulonephritisGlomerulonephritis ArteriosclerosisArteriosclerosis Congenital abnormalities of urinary systemCongenital abnormalities of urinary system Obstructions of urinary systemObstructions of urinary system ToxinsToxins Polycystic kidney diseasePolycystic kidney disease InfectionInfection Kidney stonesKidney stones Trauma )physical injuryTrauma )physical injury) )

Diet and medications are important Diet and medications are important treatments for kidney failure. In the early treatments for kidney failure. In the early stages of kidney disease, simple diet stages of kidney disease, simple diet changes can help you feel better. changes can help you feel better.

Your nephrologist and dietitian will construct Your nephrologist and dietitian will construct a diet to help preserve your kidney function. a diet to help preserve your kidney function.

Your nephrologist may also order Your nephrologist may also order medications to help problems such as blood medications to help problems such as blood pressure control and water removal pressure control and water removal

Diet and the KidneyDiet and the Kidney

Progression of CRFProgression of CRF Control of HypertensionControl of Hypertension Prevention of ComplicationsPrevention of Complications

CardiovascularCardiovascular

Renal bone diseaseRenal bone disease NutritionNutrition

Diet and Renal Bone Disease in CRFDiet and Renal Bone Disease in CRF

Low Phosphate Low Phosphate 1000 1000 mg/daymg/day

High CalciumHigh Calcium

++

Calcium supplementsCalcium supplements

Vitamin DVitamin D

Diet and the KidneyDiet and the Kidney

Protein Protein low/highlow/high Sodium Sodium low (60 mmol/d)low (60 mmol/d)

• • Potassium Potassium low (60 mmol/d)low (60 mmol/d)

• • Calcium highCalcium high

• • PhosphorusPhosphorus low (1000 mg/d)low (1000 mg/d)

• • LipidsLipids lowlow

Nutrition in Kidney DiseasesNutrition in Kidney Diseases

Prevalence of malnutrition in ESRDPrevalence of malnutrition in ESRD

Protein stores depleted Protein stores depleted 40%40% Fat stores depleted Fat stores depleted 60%60% Decrease body weight Decrease body weight ~ 50%~ 50%

Monitoring Nutrition in Kidney DiseaseMonitoring Nutrition in Kidney Disease

Anthropometric measurementsAnthropometric measurements

HeightHeight WeightWeight Body mass indexBody mass index Mid arm circumference (MAC)Mid arm circumference (MAC) Triceps skin fold thickness (TSF)Triceps skin fold thickness (TSF) Mid arm muscle circumference (MAMC)Mid arm muscle circumference (MAMC)

Monitoring Nutrition in Kidney Monitoring Nutrition in Kidney DiseaseDisease

Subjective Global Assessment (SGA)Subjective Global Assessment (SGA)

Changes in food intakeChanges in food intake Weight lossWeight loss OedemaOedema Muscle wastingMuscle wasting Functional changesFunctional changes GI disturbancesGI disturbances

Monitoring Nutrition in Kidney DiseaseMonitoring Nutrition in Kidney Disease

Biochemical markersBiochemical markers Total proteinTotal protein AlbuminAlbumin Pre-albuminPre-albumin TransferrinTransferrin ComplementComplement Insulin-like growth factor-IInsulin-like growth factor-I

Nutrition in Kidney DiseaseNutrition in Kidney Disease

ManagementManagement

Increase nutrients intakeIncrease nutrients intake Provide soluble vitaminsProvide soluble vitamins Switch off CatabolismSwitch off Catabolism Switch on AnabolismSwitch on Anabolism

Nutrition in Kidney DiseaseNutrition in Kidney Disease

Increase Nutrients IntakeIncrease Nutrients Intake

Optimise dialysisOptimise dialysis Correct anaemiaCorrect anaemia Oral supplementsOral supplements Parenteral supplements (IDPN)Parenteral supplements (IDPN)

Nutrition in Kidney DiseaseNutrition in Kidney Disease

Switch off CatabolismSwitch off Catabolism

Correct metabolic acidosisCorrect metabolic acidosis Control MicroinflammationControl Microinflammation Decrease Anabolic hormones Decrease Anabolic hormones

resistance resistance – – Adequate dialysisAdequate dialysis

Nutrition in Kidney DiseaseNutrition in Kidney Disease

Switch on AnabolismSwitch on Anabolism

Administer GHAdminister GH Administer IGF1Administer IGF1 Combination of GH/IGF1Combination of GH/IGF1

Recently in Japan they found that :Recently in Japan they found that :

the long-term intake of diacylglycerol the long-term intake of diacylglycerol

)DAG oil( prevented the progression of )DAG oil( prevented the progression of renal function in the subjects of type 2 renal function in the subjects of type 2 diabetes with nephropathy, delaying the diabetes with nephropathy, delaying the onset of dialysis. onset of dialysis.

Kidney StonesKidney Stones

Develop when stone constituents becomeDevelop when stone constituents become concentrated in urine )i.e. individual doesconcentrated in urine )i.e. individual does not drink enough fluids each daynot drink enough fluids each day( ( ~75% ~75% of stones are composed of calciumof stones are composed of calcium oxalateoxalate Some stones are composed of uric acidSome stones are composed of uric acid ((associated w/ gout(, cystine, associated w/ gout(, cystine,

ormagnesium ammonium phosphateormagnesium ammonium phosphate

Prevention of Kidney StonesPrevention of Kidney Stones

Drink plenty of fluids each dayDrink plenty of fluids each day Consume adequate dietary calciumConsume adequate dietary calcium – – Dietary calcium combines with oxalate in theDietary calcium combines with oxalate in the intestinesintestines . . reducing oxalate absorptionreducing oxalate absorption – – Low calcium diets promote oxalate absorptionLow calcium diets promote oxalate absorption Limit foods high in oxalateLimit foods high in oxalate – – Berries, chocolate, beets, spinach, rhubarbBerries, chocolate, beets, spinach, rhubarb, , wheat bran, tea, nutswheat bran, tea, nuts Moderate intake of proteinModerate intake of protein

Trivia: the record holder for kidney stones is Don Winfield of Ontario,Trivia: the record holder for kidney stones is Don Winfield of Ontario,Canada who produced and passed 4,504 stones in his lifetime; heCanada who produced and passed 4,504 stones in his lifetime; heeventually had to have this kidney removed!!eventually had to have this kidney removed!!

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