Diet in chronic renal failure. Therapeutic nutrition for kidney disease. Nutrition in chronic renal failure
The kidney removes nitrogenous waste from the body, participates in the metabolism of fats and carbohydrates, controls the content of water and microelements in the body. We don't need to think about these processes as long as the kidney is working well. But if kidney failure has appeared, then the protein-energy and water-electrolyte balance has to be maintained with the help of a strict diet. In this article, we will talk about what to eat with kidney failure and which foods should be avoided.
Basic principles of diet for kidney failure
- Quantity is limited.
- The content of sodium (salt) in food is reduced.
- The amount of phosphorus in the diet is reduced.
- The content of potassium is reduced and strictly monitored.
- The flow of fluid into the body is regulated.
- Sufficient energy value of the diet is controlled.
Why is protein limited?
In renal failure, the patient must drastically limit the intake of foods high in protein. This will reduce the burden on the kidneys.The end products of nitrogen metabolism are toxic, they increase the burden on the kidneys and contribute to the progression of the disease. The kidneys bear the brunt of their excretion and when toxins accumulate in the body, causing headache, loss of appetite, nausea and vomiting.
Dietary protein restriction is recommended as early as the first stage of chronic kidney disease (CKD). The protein content in food is allowed at the rate of 1 g/kg of the patient's ideal body weight.
At the second stage, the allowable rate is 0.8 g / kg, and at the third and subsequent stages - 0.6 g / kg. In fact, this is very small, therefore, in order to avoid exhaustion of the patient, from the third stage the doctor will recommend that the patient additionally take keto acids (ketosteril, 1 tablet per 5 kg of ideal body weight per day) or amino acids (soy isolate, 0.3 g per kilogram of ideal body weight body per day).
Why is it important to limit salt content?
The exchange of sodium is closely related to the exchange of water. Sodium retention in the body with renal failure leads to water retention, which means it exacerbates hypertension and contributes to the development of edema.
Already at the first stage of CKD, it is recommended to reduce sodium intake to 2.4 g. One gram of table salt contains 0.4 g of sodium. It is worth salting already cooked food, and when calculating the amount of an acceptable dose, one should not forget that sodium is also contained in the products themselves, and not just in the salt shaker. In practice, with a normal diet that does not include, for example, herring or sauerkraut, you can use 3-3.5 g of salt per day for cooking - this is an incomplete teaspoon.
Why limit phosphorus intake?
With renal failure, the excretion of phosphates slows down, the amount of phosphorus in the body increases, the production of parathyroid hormone, which extracts calcium from the bones, is activated, and osteoporosis develops.
Phosphorus enters the body usually with protein foods, so protein restriction in the diet also reduces the intake of phosphorus, however, the phosphate-protein ratio (phosphorus / protein ratio in 100 g of product) can vary significantly: 9 for pork and 65 for processed cheese. It is recommended to give preference to products whose coefficient does not exceed 20, and to feast on others no more than 2 times a week.
Reducing the intake of phosphorus to 0.8-1g/day is recommended from stage 3 of CKD.
Why is the potassium content reduced?
With renal failure, hyperkalemia develops - a dangerous condition that leads to a violation of the heart rhythm up to a sudden cardiac arrest. Another symptom of high potassium levels in the blood is muscle weakness.
To limit the daily intake of potassium begins with stage 3 CKD, the allowable dose is 2-4g / day.
High potassium content in all dried fruits, bananas and avocados, potatoes, greens and nuts, chocolate, wheat bran and sprouts, legumes.
Why is water restricted?
To avoid fluid retention in the body, with kidney failure, water intake should be limited. Patients with renal insufficiency are often thirsty and tend to drink large amounts of fluid, but the kidney is often unable to excrete water adequately, resulting in hypertension and edema.
Starting from the first stage of CKD, it is recommended to limit the total amount of fluid entering the body to 2 liters. Starting from stage 3, the amount of daily urine may decrease, in which case the rule comes into force: you can drink as much as the day before was allocated urine + 400 ml. Urine output should ideally be measured daily, or at least at least twice a week.
If it is difficult to cope with thirst, it is recommended to freeze part of the daily allowance and suck on ice cubes.
How to ensure sufficient energy value of the diet?
Excess weight contributes to the progression of renal failure and exacerbates the tendency to hypertension, but underweight is also unsafe: such patients are more difficult to enter dialysis and have more complications, so the caloric content of the diet in renal failure should be sufficient.
Since proteins are limited in kidney failure, fats and carbohydrates become the main sources of energy. At the same time, excessive consumption of fats raises the level of cholesterol and triglycerides, which, in combination with lipid metabolism disorders caused by kidney failure, can lead to the pathology of the cardiovascular system. Therefore, it is better to rely on vegetable fats - olive, corn, linseed oil.
Foods containing carbohydrates are often banned due to their high potassium content (dried fruits or potatoes, for example). It is necessary to include cereals in the diet, especially rice or corn.
Paradoxically, alcohol comes to the rescue of a CKD patient. At low nutritional value it has a high energy potential, therefore, from stage 3, 20 g / day of alcohol for women and 60 for men can be recommended, and preference is given to wines.
What to do if there is no appetite, but there is nausea and vomiting?
- To make meals more frequent, the environment pleasant, and the serving beautiful.
- Eat dry first solid food, and switch to liquid if nausea does not increase.
- Do not drink food, drink one hour before or one hour after a meal.
- Do not starve, when a feeling of hunger appears, immediately have a snack with something allowed, for example, dry cookies.
- If you have an unpleasant taste in your mouth, chew gum, or suck on slices of lemon, or rinse your mouth with baking soda.
It is not easy to follow a diet for kidney failure - there are many restrictions, many factors that must be taken into account. But this is one of the most effective ways to slow down the progression of the disease and prevent complications.
Which doctor to contact
For nutritional issues in chronic kidney disease, you should contact a nephrologist. A dietitian can also provide detailed advice.
In chapter diet for kidney failure the characteristics of the diet for renal failure in the initial and severe stages, excluded and recommended foods and dishes, chemical composition, culinary processing of foods, diet, daily set of foods, menu, fasting days, as well as recipes recommended by nutritionists for a diet with kidney failure.
Chronic kidney failure that occurs with chronic nephritis, bilateral pyelonephritis, amyloidosis of the kidneys, nephrosclerosis is a violation of the nitrogen excretion function of the kidneys, as a result of which protein metabolism products accumulate in the body, the amount of residual nitrogen in the blood increases, and water-salt metabolism is disturbed.
With the most severe degree of kidney failure, poisoning of the body with protein metabolism products (uremia) occurs.
The basic principles of the diet for kidney failure:
Restriction of proteins to 20-70g per day, depending on the severity of kidney failure.
Regulation of the intake of table salt, taking into account the severity of edema, hypertension, protein excretion in the urine.
Ensuring the calorie content of the diet at the expense of fats and carbohydrates.
In the early stages of renal failure,
Diet for kidney failure in the initial stage contains 70g of protein (of which up to 30% are animal proteins) or 60g of protein, of which 40-50% are animal proteins.
Diet for advanced renal failure contains 20 g of protein (diet No. 7a) or 40 g of protein (diet No. 7b), 70-75% of which are animal proteins from meat, fish, dairy products, eggs. Fluid intake is 1-1.5 liters per day, but it should correspond to the amount of urine excreted over the previous day, plus 0.4-0.6 liters.
In case of severe renal failure, it is first prescribed, when the patient's condition improves, they are transferred to, against which the 7a diet is periodically used.
During the application of diet 7a, the patient is periodically given 2-4 g of salt on his hands to add salt to food. When edema occurs, salt is again limited to 1 g or excluded.
The diet for kidney failure includes fasting carbohydrate days:
Apple-sugar, rice-compote, potato.
1. Apple-sugar diet: 1.5kg ripe or baked apples per day, divided into 5 doses of 300g, 50-100g of sugar
2. Rice and compote diet: per day 1.5 fresh fruits or 240g dried fruits, 120g sugar, 50g rice. Boil compote and rice porridge in water. 1 glass of sweet compote 6 times a day, 2 of them with sweet rice porridge, boiled without salt on water.
3. Potato diet: 1.5 kg of potatoes per day. Boil potatoes in their skins without salt or bake. Eat 300g of potatoes 5 times a day.
4. Special potato diet prescribed for chronic glomerulonephritis with renal failure: potatoes - 1 kg (net weight), other vegetables or fruits - 300 g, vegetable oil - 50 g, butter - 70 g, sugar - 50 g.
Culinary processing for a diet with renal failure in a pronounced stage:
Culinary processing of products for diets No. 7a and 7b without mechanical sparing.
Food is boiled, followed by baking and light frying.
Diet for renal failure, diet:
Take food 5-6 times a day.
Food is cooked without salt, bread is given salt-free.
Exclude from the diet for renal failure in a pronounced stage:
1. Ordinary bread, flour products with the addition of salt.
2. Meat, fish, mushroom broths, milk soups, soups with cereals (except sago) and legumes.
3. All meat and fish products (canned food, sausages).
5. All cereals (limit rice) and pasta.
6. Pickled, salted, pickled vegetables.
7. Sorrel, spinach, cauliflower, legumes, garlic, radish, mushrooms.
8. Chocolate, ice cream, milk jelly.
9.meat, mushroom, fish sauces, mustard, horseradish, pepper.
10. Natural coffee, cocoa, mineral water containing sodium.
11. Pork, beef, mutton fats.
Diet number 7a:
-Soups vegetarian with sago, vegetable, potato, fruit, taking into account the permitted liquid. Soups are seasoned with sour cream, herbs, boiled and then browned onions.
- Meat and fish dishes: 50-60 (gross weight) lean beef or veal, pork (lean meat), rabbit, chicken, turkey, fish. Meat and fish boiled, baked or lightly fried after boiling, in pieces or chopped.
- Milk products: 60g of milk, cream, sour cream, cottage cheese - with the exception of meat and fish.
-cereals- only sago, limited rice, only protein-free pasta. Cooking dishes in milk or water in the form of cereals, pilaf, cutlets, casseroles, puddings.
-Eggs: 1/4-1/2 eggs per day (omelette, soft-boiled).
- Vegetables: potatoes 200-250g and fresh vegetables 400-450g (gross weight) in the form of various dishes. Boiled and fried onions as an additive to dishes, dill and parsley.
- different fruits and berries in raw, dried, baked form, sugar, honey, jam, non-chocolate sweets, jelly, compote, jelly.
- To improve taste dishes use greens, sour fruit and vegetable juices.
- Snacks: vegetable salads with vegetable oil.
-Sauces: tomato, sour cream, sweet and sour sauces, vegetable and fruit sauces. Fried onion after boiling lemon acid, cinnamon, vanillin.
.- Fats: unsalted butter, ghee, vegetable oil.
- Flour products: 100 g of protein-free, salt-free corn starch bread, in the absence of such bread, 50 g of salt-free wheat bread or other salt-free flour products baked with yeast.
-The drinks: fruit and berry juices, tomato juice, rosehip broth, weak tea with lemon.
Diet 7b:
In diet 7b, the amount of protein is doubled due to the inclusion of 125 g of milk and sour cream, 125 g of meat or fish, and 1 egg. Cottage cheese is given only with the exclusion or reduction of meat and fish.
Also in diet 7b, the amount of potatoes was increased to 300g, other vegetables - up to 650g, salt-free, protein-free bread up to 150g, sago (rice).
Daily set of products for diet No. 7a(Samsonov M.A. 1981):
Salt-free, protein-free bread - 100g, meat - 62g, eggs - 1/4pc, milk - 30g, sour cream - 30g, vegetable oil - 7g, butter - 90g, sugar - 80g, sago - 55g, potatoes - 235g, white cabbage - 150g, carrot - 70g, beetroot - 130g, onion - 30g, green onion - 15g, greens - 10g, radish - 20g, fresh cucumbers - 20g, parsley - 7g, tomato - 7g, flour - 18g, corn starch - 70g.
Daily set of products for diet No. 7b(Samsonov M.A. 1981):
Protein-free, salt-free bread - 150g, meat - 125g, milk - 80g, eggs - 48g (1pc), sour cream - 45g, butter - 80g, vegetable oil - 20g, sago - 70g, sugar - 110g, potatoes - 335g, carrots - 80g, white cabbage - 225g, beetroot - 200g, greens - 20g, green onion - 15g, onion - 40g, green peas - 20g, radish - 35g, fresh cucumbers - 40g, parsley - 7g, tomato - 15g, flour - 28g , cornstarch - 80g.
For acute renal failure as a result of poisoning (for example: sublimate, mercury), acute infections, injuries, acute nephritis, severe burns, a diet of 7a (proteins 20-25g) is prescribed, of which animal proteins are 70-75%. The amount of fluid injected should correspond to the amount of urine for the previous day + 0.5l.
The caloric content of the diet should be sufficient so that there is no breakdown of proteins for replenishment. energy costs organism.
With end-stage kidney failure with a sharp deterioration in kidney function, 20-25 g of protein is prescribed, salt is increased to 8-12 g, free fluid - up to 2 liters.
Diet for kidney failure depending on the stage of kidney failure:
1.initial stage- diet No. 7 when replacing bread with protein-free (1 g of protein per 1 kg of patient weight) or diet No. 7 with fasting days, diet 7b (protein 40g, animals - 70-75%) or diet No. 7 (protein 70g, vegetable - 70-75% ).
2.Pronounced stage:
- oligosymptomatic: diet 7b with periodic appointment of diet 7 (load days).
- multisymptomatic: diet 7b with fasting days diet 7a (protein 20g, of which animals - 70-75%).
3.Final stage:
-uncomplicated: with hemodialysis, diet No. 7 is prescribed with fasting days, diet 7b or diet 7g (protein 60g, of which animals - 75%).
- complicated: diet 7a with load days diet 7b.
Diet menu number 7a for 1 day:
1st breakfast: milk sago porridge, apple and carrot cutlets baked in vegetable oil, tea.
2nd breakfast: fruits are fresh.
Dinner: 1/2 servings of vegetarian soup from prefabricated vegetables, boiled potatoes, boiled meat with tomato sauce, jelly.
afternoon tea: a decoction of wheat bran with sugar.
Dinner: vegetable salad in vegetable oil, sago pilaf with fruit. Tea.
For the night: fruit juice.
Diet menu number 7b for 1 day:
1st breakfast: apple and rice pudding, vegetable salad with vegetable oil, tea.
2nd breakfast: raw grated carrots with sugar
Dinner: vegetarian vegetable soup (1/2 servings), boiled potatoes, boiled chicken with milk sauce, dried fruit compote.
afternoon tea: a decoction of wheat bran with sugar.
Dinner: apple pancakes, 1 soft-boiled egg, tea.
Renal failure complicates the course of many diseases of the excretory system. The treatment of this condition should be comprehensive and include not only medication, but also the implementation of the doctor's recommendations on lifestyle. And what should be the diet for kidney failure? About acceptable and prohibited products, as well as general scheme nutrition will talk in our review.
Who can face this problem
It is important to understand that kidney failure is not a single disease, but a syndrome that has many different reasons. The acute form of pathology develops with:
- violation of blood circulation in the vascular bed caused by heart failure, arrhythmia, shock, etc.;
- massive death of nephrons (functional units of kidney tissue);
- pathologies that cause acute violation of the outflow of urine.
Chronic renal failure (CRF) is more often the result of a sluggish pathology of the urinary organs - pyelonephritis, glomerulonephritis, urolithiasis. Often this condition is diagnosed against the background of diabetes mellitus, rheumatism, gout and other metabolic disorders.
The name of the disease speaks for itself. With renal failure, a violation of all functions of the organs of the urinary system develops:
- excretory;
- osmoregulatory;
- ion-regulating;
- intrasecretory;
- metabolic.
Diet in kidney failure can reduce Negative influence not excreted metabolic products on the body and reduce the increased burden on the gastrointestinal tract. Proper nutrition"helps" the kidneys work better and reduces the risk of possible complications.
Fundamentals of clinical nutrition
Specialized nutrition for kidney failure was called the therapeutic diet number 7 (Pevzner table). It is aimed at:
Reducing the amount of protein consumed to 40-60 grams per day B in large numbers the products of protein metabolism in the body have a toxic effect and "load" the kidneys with unnecessary work. Providing a person with all the nutrients This is done mainly due to dairy and vegetable foods rich in fats, carbohydrates and easily digestible protein. Restriction of salt to 1 g / day Salt has the ability to retain water in the vascular bed. Drinking regimen agreed with the doctor Patients with renal insufficiency may have to limit fluid intake to 1.0-1.2 liters per day. Optimal cooking All products are recommended to be consumed boiled, stewed, baked or steamed. 
What can you eat with kidney failure? Among the allowed products are:
- cereals: rice, buckwheat, sago;
- unleavened bread;
- light soups in vegetable broth;
- lean meat (chicken breast, turkey, rabbit, veal);
- fish;
- seasonal vegetables (carrots, beets, potatoes, pumpkins, turnips, tomatoes), greens;
- eggs (no more than one per day);
- processed fruit in the form of jam, jam, jelly, mousse, etc.
Prohibited in case of illness:
- alcohol in any form;
- strong coffee, tea, cocoa, hot chocolate;
- overly salty dishes, pickled vegetables;
- mushrooms;
- foods rich in saturated fatty acids and trans fats (pork and beef fat, kidneys, brains, tongue and other offal, margarine, cooking oil);
- vegetables and fruits that cause increased gas formation in the intestines (cabbage, spinach, peas, beans and other legumes, bananas, apricots);
- canned food and sausages.
Diet for acute kidney failure
The diet for acute renal failure should be aimed at facilitating the work of the excretory system and preventing the development of complications. The situation is complicated by the fact that at an early stage of the disease, patients are usually unconscious and require parenteral nutrition. Then, as vital functions are restored, they can be transferred to a therapeutic diet.
The main principle of nutrition correction in acute renal failure remains the restriction of protein intake to 40-70 g / day. At the same time, the total calorie content of the diet should remain relatively high in order to avoid the destruction of the body's own tissues and increase the load on the kidneys.
This is achieved through complex carbohydrates found in cereals, fruits and vegetables, as well as fats rich in healthy omega-3, 6.
When replenishing the supply of nutrients, vitamins and trace elements, the following are considered especially useful:
- freshly squeezed juices - apple, cherry, plum, melon;
- vegetables - potatoes, carrots, cauliflower, beet;
- fresh greens.
With proper treatment, complete recovery of patients with acute renal failure occurs in 6-24 months. Compliance with the diet during this period is very important for a speedy recovery and normalization of kidney function. In the future, the patient can gradually expand the list of allowed products.
Diet for chronic renal failure
The diet for chronic renal failure should be followed by the patient for life. At the initial stage of the disease, a slight restriction of protein in the diet is expected - up to 1 g / kg of body weight.
- cereals and bread;
- vegetables;
- nuts.
It is important for patients with chronic renal failure to consume enough nutrients, so the calorie content of food should be high. There is no need to severely limit salt, but its amount per day should not exceed 3-4 grams.
The amount of liquid allowed for consumption during the day should be agreed with the attending physician. Standard instructions recommend drinking 500 ml more water than was excreted in the entire previous day in urine.
- watermelon;
- apples;
- pumpkin.
Diet with severe insufficiency of the excretory system becomes more stringent. The amount of protein consumed daily is limited to 20-25 g, and 70-80% of this amount should be easily digestible animal food - lean meat, fish, poultry, eggs. Salt is limited to 3 g / day if there is no edema.
With an increase in symptoms of kidney failure, it is recommended to switch to a completely salt-free diet. So that the food does not seem insipid, you can use spices (except for hot ones - pepper, mustard, horseradish), herbs, herbs, lemon juice.
The daily menu of patients with chronic renal failure may look like this:
Breakfast
- Boiled potatoes;
- omelette from one egg;
- Orange juice.
- natural yogurt with berry puree;
- mineral water.
- vegetable soup with buckwheat;
- eggplant stew, bell pepper and carrots;
- apple jelly.
- rye bread with butter;
- rosehip decoction.
- rice porrige;
- jam;
- plum juice.
Diet remains one of the common methods of treating formidable diseases of the urinary system: with kidney failure, it is not difficult to follow it, because its menu is quite diverse, and the calorie content is high. Compliance with medical recommendations significantly improves the patient's prognosis, and reduces the severity of symptoms of pathology.
The kidneys play an important role in life human body. For the normal functioning of this body, it is necessary to adhere to certain nutritional rules. Diet for kidney failure is considered a mandatory part of the treatment. Without this component of therapy, it is impossible to talk about improving the human condition.
This disease is very dangerous for health and life, so you need to take it seriously. The doctor will tell you what you can eat and what you can not eat if this disease is diagnosed in the patient. Kidney failure is a condition in which the kidneys do not carry out their functions, metabolic processes body are disturbed, water, nitrogen, electrolytes, all this can not be excreted from the human body. Such disorders can be the result of many diseases.
Note! It is important to consider that kidney failure can be acute and chronic, each of the varieties requires its own diet.
In addition to diet, the treatment of this disease includes some procedures and medications - such therapeutic manipulations are aimed at restoring the functions of this organ.
Nutrition Features
Restriction in nutrition, with renal failure, should be aimed at reducing the load on the kidneys to ensure their normal functioning. There are certain rules that must be followed. Protein should be consumed in an amount of 60-40g per day, it is also necessary to supply amino acids to the body, and salt should be almost completely eliminated - the daily volume of salt should not exceed 1 g.
In addition, nutrition in renal failure is adjusted depending on the individual characteristics of the person. Despite the fact that the amount of protein consumed should be low, fats and carbohydrates are needed by the body in large quantities. Bread is necessarily included in the diet of such patients, but only corn or wheat.
We must not forget about the regular intake of vitamins, which are necessarily included in the diet for kidney failure. Berries, fruits, vegetables, juices are excellent sources of these elements.
Diet therapy also excludes the use of certain drinks that irritate the kidneys. Many people forget to pay attention to the fluid they consume, and this is very important. Strictly prohibited drinks and foods:
There is a list of certain foods that can be consumed with kidney failure, but the amount of such food should be agreed with the doctor, these are:
- Dried fruits.
- Caviar.
- Dairy products.
- Various nuts.
- Fatty fish.
- Sunflower seeds.
- All beans.
The basics of therapeutic nutrition may vary, depending on the course of the disease. If kidney failure has just appeared, then dietary restrictions are strict, in the case of a chronic course of the disease, the doctor can further increase the list of prohibited foods. Recipes for medicinal dishes can be very diverse, patients with kidney failure have learned to make a menu, taking into account all dietary restrictions.
Basic principles of diet number 7
There is a certain kind of diet for such patients - this is diet 7. The list of prohibited and useful products, which are included in this diet menu, helps to relieve irritation from the kidneys and improve their work. If the doctor prescribes diet number 7, you need to carefully study it, understand what you can and cannot eat.
Features of diet number 7:
Cooking delicious dishes from such products is quite possible. The doctor will tell you about the features of such a diet and the duration of its observance.
Important! If a patient with chronic renal failure has a concomitant disease, such as diabetes, then the diet should be adjusted.
From the diet of patients with diabetes mellitus and renal failure, it is necessary to exclude:
In the case of diabetes mellitus and renal insufficiency, the doctor regulates the nutrition of such a patient, since this situation is considered very difficult. In diabetes, carbohydrates are prohibited, this element increases blood glucose, which must be taken into account.
How to make a menu based on diet number 7?
A sample menu for the day will allow a person with chronic renal failure (chronic renal failure) to diversify their diet. Many are looking for recipes on the Internet or in special magazines, you need to carefully consider such a menu, study it in detail to identify prohibited foods.
| sample menu |
|---|
|
|
|
|
Everyone can create different dishes on their own, you just need to show imagination. The diet for chronic renal failure is usually more strict, since the human body is already quite weakened.
If the disease continues for a long period, disorders that arise due to bad work kidneys, destroy all systems and organs of the body.
Many are concerned about the variety of useful and permissible products for this disease. For example, dried fruits and bananas are considered very healthy food, but their inclusion in the menu of patients with kidney failure is prohibited. The answer lies in the composition of such products. The fact is that during the course of this pathology, the human body is not able to remove potassium that enters the bloodstream. Bananas, as well as dried fruits, are rich in this substance, so you can’t saturate it even more with potassium.
The preparation of therapeutic nutrition is based not only on improving the functioning of a particular organ, but also on stabilizing the state of the whole organism. Doctors develop special recommendations that help improve the health of people with various diseases. Therefore, in case of renal failure, compliance with such a menu is extremely important, otherwise the disease will only progress, which can lead to death.
Medical nutrition is prescribed simultaneously with anti-inflammatory, desensitizing and symptomatic therapy.The main requirements for the diet of patients with acute diffuse glomerulopephritis: 1) restriction of salt and water; 2) restriction of simple carbohydrates; 3) protein restriction; 4) reducing the caloric content of the diet, taking into account the level of energy expenditure of the body; 5) exclusion of extractive substances from the diet and full provision of the patient's need for vitamins and minerals.
Based on clinical experience, it is most advisable to prescribe to patients with acute diffuse glomerulonephritis in the first 2-3 days of sodium-free nutrition in the form of contrast days, the choice of which is determined by the tastes of the patient and his tolerability of technical products and dishes. In this case, potato, apple, watermelon, pumpkin, or bapap, sugar, compote, kefir and other days are used. For the whole day, the patient is given 1.2 kg of peeled boiled or baked potatoes, or 1.5 kg of ripe apples, or 1.5 kg of ripe peeled watermelon, or 150 g of sugar, or 1.5 liters of compote made from fresh fruits or dried fruits, or 1.2 kg of peeled bananas, or 1.2 kg of baked or boiled pumpkin with sugar. The total amount of the product is divided into 5 servings and given to the patient 5 pas per day.
The amount of liquid recommended to the patient (rosehip broth, diluted fruit juice, weak tea, milk, etc.) is determined as follows: 400 ml of liquid is added to the daily diuresis, i.e. if the patient excreted 500 ml of urine per day, then the allowable amount liquid during the day will be equal to 900 ml. On watermelon and compote fasting days, the patient is not given liquid.
Appointment to a patient with acute nephritis unloading sodium-free days in the first 2-3 days helps to reduce edematous syndrome, lower blood pressure, improve the general condition. From the 3rd-4th day of treatment, the patient should be transferred to a salt-free diet No. 76 containing 40 g of protein, 80 g of fat and 450 g of carbohydrates, with a total calorie content of 2700 kcal. Protein in this diet is introduced mainly at the expense of egg, milk and fish proteins, which are more easily absorbed by the body and contain less extractive substances. This protein-deficient diet is the mainstay in the treatment of patients with chronic renal failure. Approximate one-day diet menu No. 7b.
In acute diffuse glomerulonephritis, the excretory function of the kidneys, as a rule, is not significantly impaired, therefore, as the patient's condition improves, the diet must be expanded primarily by increasing the protein quota. At the beginning of the 3rd week of the acute period of the disease, subject to a decrease in the severity of the urinary syndrome, the patient is transferred to a salt-free diet No. 7. Chemical composition diets: proteins 80 g, fats 85 g, carbohydrates 450 g. The calorie content of the diet is 2900 kcal.
In table. an approximate one-day menu of this diet is given.
On this diet, the patient must be until the end of his stay in the hospital. If the patient's condition worsened somewhat during the transfer to diet No. 7, it is necessary to assign him diet No. 76 again for 2-3 days in order to then return to diet No. 7. This “zigzag” sometimes has to be repeated twice in order to adapt the body patient to new nutritional conditions.
When a patient is discharged from a hospital and his condition progressively improves, the amount of protein can be increased to 90 g and meat can be included in the diet mainly in boiled form, followed by baking. The content of salt and simple carbohydrates, which have a sensitizing effect, is limited in the next 3-4 months, i.e., until the residual effects of acute nephritis are completely eliminated,
Approximate one-day diet menu No. 7 (2881 kcal)
Name of dishes | Yield, g | Proteins, g | Fats, g | Carbohydrates, g |
| First breakfast | ||||
| Soft-boiled eggs (2 pcs.) | 48 | 10,2 | 10,9 | 0,5 |
| Loose buckwheat porridge with butter | 90 | 4,3 | 4,8 | 25,0 |
| Tea with milk | 200 | 1,4 | 1,7 | 2,3 |
| Lunch | ||||
| Pumpkin porridge with semolina | 280 | 8,0 | 9,0 | 49,0 |
| Dinner | ||||
| Vegetarian borscht (1/2 portion) | 250 | 2,3 | 6,8 | 16,7 |
| Boiled meat | 55 | 15,9 | 3,2 | - |
| Fried potato | 125 | 2.6 | 7,9 | 30,1 |
| Fresh fruit compote | 200 | 0,3 | - | 27,8 |
| afternoon tea | ||||
| Carrot-apple meatballs baked | 230 | 6,7 | 7,2 | 43,0 |
| Fruit pilaf (1/2 portion) | 90 | 1,9 | 6,1 | 38,2 |
| Apple juice | 200 | 0,8 | - | 23,4 |
| For the night | ||||
| Kissel from prunes | 200 | 0,5 | - | 46,9 |
| All day | ||||
| Bread bran, salt-free | 250 | 25,0 | 12,0 | 91,0 |
| Sugar | 50 | - | - | 49,9 |
| Butter | 20 | 0,12 | 16,5 | 0,18 |
| Total | 79,5 | 86,1 | 445,7 |
Therapeutic nutrition in chronic renal failure
Chronic renal failure (CRF) is a symptom complex caused by irreversible, severe damage to kidney function. Kidney failure cannot be reduced only to a violation of the nitrogen-excreting function of the daughters and the accumulation of nitrogenous slags in the body, the toxic effect of which has long been considered the main cause of uremia. The deterioration of kidney function leads to severe changes in water and electrolyte metabolism, as well as to metabolic disorders, which, along with azotemia, is essential in the pathogenesis of chronic renal failure and often determines the course of uremia and its outcome.The task of conservative therapy in chronic renal failure is to influence water and electrolyte disturbances, acidosis, cardiovascular insufficiency, arterial hypertension and other disorders from the side of internal organs. Dietary therapy is an obligatory component of the complex treatment of patients with chronic renal failure.
The concentration of the end products of nitrogen metabolism (residual nitrogen, urea, uric acid, creatinine, etc.) in the blood serum depends on the amount of protein ingested with food, the level of protein catabolism, and the degree of renal failure. Since the majority of CKD patients fail to significantly improve kidney function with medication alone, a low-protein diet is the only way to reduce azotemia.
Currently, the dietary treatment of chronic renal failure is based on the following basic principles: 1) restriction of protein intake with food to 20-40-60 g per day, depending on the severity of renal failure; 2) ensuring sufficient calorie content of the diet due to fats and carbohydrates, corresponding to the body's energy expenditure, full provision of vitamins, macro- and microelements; 3) restriction of salt and water entering the body in case of arterial hypertension to the minimum limits at which it is possible to maintain the normal water and electrolyte composition of the internal environment of the body. A significant restriction of protein in food can lead to a decrease in the total protein in the body, which limits the formation of enzymes, antibodies, hormones that are necessary for the normal functioning of the body. Therefore, the construction of a dietary diet for a patient with CRF is reduced to determining the optimal amount of protein that will not cause a dangerous increase in the content of nitrogenous wastes, and, at the same time, will not lead to the breakdown of the body's own proteins due to protein starvation. In other words, in patients with chronic renal failure, it is necessary to maintain a nitrogen balance in conditions of reduced protein intake from outside.
Therapeutic diets for patients with chronic renal failure
Based on the created protein-free products, the Institute of Nutrition of the Academy of Medical Sciences developed two variants of a low-protein diet containing 20 g of protein (diet No. 7a) and 40 g of protein (diet No. 76).In diets No. 7a and 76, 3/4 of the protein is animal protein (meat, eggs, milk) as the most complete in terms of the content of essential amino acids. This proportion of animal protein made it possible to provide diet No. 7a with a minimum amount of essential amino acids, at which nitrogen balance is observed, and diet No. 76 - with the amount of essential amino acids corresponding to the daily requirement for them to maintain nitrogen balance in the body of an adult (table).
The content of essential amino acids in low-protein diets (in grams)
The calorie content of diets is provided by fats and carbohydrates, the content of which does not significantly exceed the physiological norm. Great attention in the preparation of diets should be paid to the taste of the diet. To improve the taste of food, it is allowed to add spices, herbs, sour vegetable and fruit juices (lemon, orange, cherry plum, tomato, etc.).Both diets are hyposodium. All food is prepared without salt, its content in the products themselves is 2-3 g per day. If the patient does not have cardiovascular insufficiency, high blood pressure, pronounced edema, an additional 3 g of salt is given to his hands. Patients can consume 1-1.5 liters of fluid, taking into account daily diuresis. The liquid is given in the form of diluted fruit and vegetable juices, alkaline mineral water or intravenous drip infusions of 4% sodium bicarbonate solution and 5% glucose solution with severe intoxication.
The daily set of products included in the diets No. 7a and 7b, the range of dishes recommended for patients with chronic renal failure, the characteristics of the diets and the one-day menu are given below.
Diet number 7 a
Indications for use. Chronic kidney disease with a pronounced violation of the nitrogen excretion function and severe azotemia.Special purpose. Sparing of kidney function; improving the excretion of nitrogenous slags and incompletely oxidized metabolic products from the body; an obstacle to the accumulation of nitrogenous slags in the blood, a slowdown in the development of uremia, as well as a decrease in hypertension.
General characteristics. Diet with the exception of CLR by a sharp restriction of table salt (depending on the severity of hypertension), a sharp restriction of protein (up to 20 g) mainly due to vegetable while introducing into the body the minimum required amount of essential amino acids with a complete animal protein. Eliminate substances and nanothreads that irritate the kidneys (alcohol, nitrogenous extractives, strong coffee, tea, cocoa and chocolate, spicy, salty snacks). Introduce foods into the diet that contain a small amount of protein and have high calorie(various sago dishes, protein-free maize starch bread, swelling starch puree and mousse). To provide the body with vitamins, various juices are given (watermelon, melon, cherry, grape, etc.).
Culinary processing. All dishes are prepared without salt. Meat and fish are given boiled or fried.
Chemical composition and calorie content of diet No. 7a. Proteins 20 g (including animals 15 g), fats 80 g (including animals 50-55 g), carbohydrates 350 g. Calorie content 2200 kcal. Table salt 1.5-2.5 g (in products). Vitamin content: retinol - 0.7 mg, karotype - 5.5 mg, thiamine - 0.45 mg, riboflavin - 0.47 mg, nicotinic acid - 4.5 mg, ascorbic acid - 268.5 mg. The content of minerals: calcium - 230 mg, potassium - 1630 mg, magnesium - 100 mg, phosphorus - 390 mg, iron - 16 mg.
The total amount of free liquid is 1-1.5 liters. The mass of the daily ration is 2.3 kg. Food temperature is normal. The number of meals - 5-6 times a day.
Bread and bakery products. Bread without protein from maize starch, white wheat bran (achloride) is baked without salt.
Soups are different, with sago, vegetables, fruits, vegetarian, prepared without salt.
Meat and poultry dishes. Lean beef, veal, chicken, turkey, rabbit boiled and then fried, cut or minced.
Fish dishes. Low-fat fish (perch, pike, saffron cod, perch, roach) boiled and then fried, in pieces or chopped.
Dishes and side dishes from vegetables and herbs. Potatoes, carrots, beets, cauliflower, lettuce, tomatoes, fresh cucumbers, parsley, green onions. Boiled, natural.
Dishes and side dishes of willows, legumes and pasta are excluded or sharply limited. Instead, they give dishes from sago and special pasta - on water and milk in the form of cereals, puddings, casseroles, meatballs, pilaf.
Egg dishes. Protein omelet and for cooking various dishes (no more than one egg per day).
Milk, dairy products and dishes from them. Whole milk, kefir, acidophilus, curdled milk, sour cream, cream (all in limited quantities).
Sauces and spices. Milk, tomato, protein-free, vegetable marinade sauce with tomato. Sweet and sour vegetable and fruit sauces with the exception of meat, fish and mushrooms
Approximate one-day diet menu No. 7a (2440 kcal)
Name of dishes | Yield, g | Proteins, g | Fats, g | Carbohydrates, g |
| First breakfast | ||||
| Sago pudding with apples | 200 | 3,2 | 6,3 | 48,0 |
| Apple puree with proteins | 140 | 1,3 | 0,9 | 41,2 |
| apricot juice | 200 | 0,8 | 28,4 | |
| Lunch | ||||
| Fruits (apples, berries, etc.) | 100 | 0.4 | - | 11,5 |
| or gourds (watermelon, melon) | 350 | 1,7 | - | 32,0 |
| Dinner | ||||
| Soup from prefabricated vegetables vegetarian (1/2 portion) | 250 | 4,8 | 9,7 |
|
| Boiled meat (1/2 portion) | 26,5 | 6,95 | 1,6 | - |
| Salad of apples, prunes, apricots | 150 | 1,5 | 5,6 | 39,3 |
| Kissel cranberry | 200 | 0,2 | - | 38,9 |
| afternoon tea | ||||
| Rosehip decoction | 200 | - | - | - |
| Dinner | ||||
| Sago pilaf with fruits (x/2 servings) | 90 | 0,47 | 5,92 | 40,72 |
| Vegetable salad with vegetable oil | 150 | 1,5 | 9,4 | 11,7 |
| Tea with sugar (sugar 10 g) | 200 | - | - | 9,5 |
| For the night | ||||
| plum juice | 200 | 0,4 | - | 33,2 |
| All day | ||||
| Protein-free bread Butter Sugar | 100 60 40 | 0,83 0,36 | 2,5 49,5 | 0,5 |
| Total | 20,5 | 86,7 | 400,2 |
Approximate one-day diet menu No. 7b (2800 kcal)
Name of dishes | Yield, g | Proteins, g | Fats, g | Carbohydrates, g |
| First breakfast | ||||
| Sago pudding with apples | 270 | 4,32 | 8,58 | 65,03 |
| Apple puree with proteins | 140 | 1,3 | 0,9 | 41,2 |
| apricot juice | 200 | 0,8 | 28,4 | |
| Lunch | ||||
| Raw grated carrots with sugar | 155 | 1,95 | - | 16,2 |
| Dinner | ||||
| Mixed Vegetable Soup Vegetarian (1/2 portion) | 250 | 9,7 | ||
| Boiled meat | 55 | 15,9 | 3,2 | - |
| Protein-free tomato sauce | 50 | 0,5 | 3,97 | 3,7 |
| Salad of apples, prunes and apricots | 150 | 1,5 | 5,6 | 39,3 |
| Cherry puree mousse | 140 | 0,78 | - | 20,2 |
| afternoon tea | ||||
| Rosehip decoction | 200 | - | - | - |
| Dinner | ||||
| Sago pilaf with fruits | 180 | 0,94 | 11,84 | 81.44 |
| Protein omelet | 110 | 8,3 | 6,5 | 3,32 |
| Tea without milk | 200 | - | - | - |
| For the night | ||||
| plum juice | 200 | 0,4 | - | 33,2 |
| All day | ||||
| Sugar | 40 | - | - | 39,8 |
| Butter | 40 | 0,24 | 33,0 | 0,36 |
| Protein-free starch bread | 150 | 1,24 | 3,7 | 71,62 |
| Total | 39,9 | 82,4 | 483 |
Daily set of products included in diets 7a and 7b (gross)
| Name of products | Product weight, g | |
| diet number 7a | diet number 7b | |
| Protein-free bread, white or bran (achloride) | 100 | 150 |
| Meat | 62 | 125 |
| Eggs | 13 (1/4 pcs.) | 48 (1 piece) |
| Milk | 30 | 80 |
| Sour cream | 30 | 45 |
| Butter | 90 | 80 |
| Vegetable oil | 7 | 20 |
| Sugar | 80 | 110 |
| Sago | 55 | 70 |
| Potato | 235 | 335 |
| White cabbage | 150 | 225 |
| Carrot | 70 | 80 |
| Beet | 130 | 200 |
| Onion | 30 | 40 |
| Green onion | 15 | 15 |
| Greenery | 10 | 20 |
| Green pea | - | 20 |
| Radish | 20 | 35 |
| fresh cucumbers | 20 | 40 |
| Parsley | 7 | 7 |
| Tomato | 7 | 15 |
| Flour | 18 | 28 |
| Corn starch | 70 | 80 |
Fats all, with the exception of refractory (lamb, pork and beef).
Sweet dishes, sweets, fruits, berries. Jelly, puree-mousse, cooked on swelling starch, sugar, honey, jam, sweets. Any fruits, berries, raw and boiled. fruit juices. Pumpkin, watermelon, melon are recommended.
In table. an approximate one-day menu of diet No. 7a is given.
Diet number 7b
Indications for the appointment of a diet, purpose, general characteristics of the diet, cooking are the same as for diet No. 7a.Proteins 40 g (including animals 25-30 g), fats 80-90 g (including animals 60-65 g), carbohydrates 450 g. Calorie content 2800 kcal. Table salt 2-3 g (in products). Vitamin content: retinol-0.95 mg, carotene -5.5 mg, thiamine -0.7 mg, riboflavin -
1.1 mg, nicotinic acid -7.5 mg, ascorbic acid - 282.7 mg. The content of minerals: calcium - 460 mg, potassium - 2650 mg, phosphorus - 690 mg, iron - 19.3 mg, magnesium - 200 mg. The total amount of free liquid is 1-1.5 liters. The mass of the daily ration is 2.5 kg. The temperature of the niche is normal. The number of meals - 5-6 times a day.
In table. a one-day menu of diet No. 7b is given.
In table. the daily set of products included in the diet No. 7 a and 7 b is given.
Dietary treatment with a sharp restriction of protein in the diet requires a sufficient calorie content of the diet (2200-2800 kcal) and a maximum reduction in vegetable proteins in it. At the Institute of Nutrition of the Academy of Medical Sciences, a team of employees of the technology department under the leadership of G. S. Korobkina developed protein-free products from starch cereal crops and swelling amylopectin starch. These products include protein-free bread, confectionery (cake, cookies), pasta, noodles, vermicelli, cereals (such as semolina, rice, etc.), fruit mousses, jellies, creams. As a substitute for cereals, artificial sago from cereals is widely used. cornstarch.
Chemical composition and calorie content of special dietary products and dishes recommended for use in low-protein diets
The chemical composition of some protein-free foods and dishes is presented in Table.Name of dishes | Yield, g | Proteins, g | Fats, g | Carbohydrates, g | Calories, kcal |
| Bread without protein cornstarch | 100 | 0,83 | 2,5 | 47,8 | 280 |
| Sago Potato Soup | 300 | 1.47 | 3,9 | 19,9 | 124 |
| Sago cutlets | 140 | 0,4 | 7.9 | 49,4 | 288 |
| Sago cabbage rolls | 250 | 5.2 | 11.0 | 30,2 | 252 |
| potato slices, stuffed sago with onion | 200 | 5,6 | 12,2 | 55,9 | 381 |
| Sago porridge crumbly oil, water | 200 | 0,5 | 11,8 | 66,0 | 383 |
| Sago porridge with milk | 150 | 1,58 | 3,8 | 25,3 | 151 |
| Sago pudding with apples | 200 | 3,2 | 6,3 | 48,0 | 276 |
| Sago casserole with dried apricots | 200 | 4,33 | 12,1 | 75,1 | 450 |
| Casserole of sago, apples and | 260 | 3,7 | 12,0 | 65,3 | 407 |
| carrots Sago pilaf with fruit | 180 | 0,94 | 11,8 | 81,5 | 463 |
| Cherry puree-mousse with swelling starch | 140 | 0,78 | - | 20,2 | 207 |
| Plum shore mousse with swelling starch | 140 | 0,38 | - | 53,3 | 220 |
Therapeutic nutrition in end-stage renal disease
Currently, the treatment of patients with end-stage renal disease (ESRD) is based on the use of chronic hemodialysis in combination with dietary therapy. When using hemodialysis, patients may develop some complications due to nutritional imbalance. Due to the fact that in patients with terminal uremia, the metabolism of proteins and amino acids in the body is disturbed, the leading direction in building a dietary regimen is to determine an adequate amount of protein in the diet and its qualitative composition. Treatment with hemodialysis, along with the leaching of toxic substances, is accompanied by a loss of amino acids, which leads to significant changes and restructuring of the amino acid spectrum of blood serum. Depending on the duration of the procedure, there is a different percentage of the decrease in the total concentration of amino acids in the blood serum: with a 6-hour hemodialysis, the level of amino acid nitrogen decreases by 16-20% of the original, with 9-10 hours - by 20-30%. During hemodialysis, valine, threonine, isoleucine, arginine and histidine are the most washed out of the essential amino acids; from interchangeable - series, citrulline, alanine, ornithine. Under the influence of hemodialysis in patients, the content of the strait, cystine, glycine and aspartic acid is normalized. The concentration of methionine and tryptophan is reduced. "Artificial kidney" filters everything that passes through the holes of the artificial membrane. Replenishment of amino acids lost in the dialysis solution should be provided by a rationally expanded diet.The dietary diet should be salt-free (hyponatric). All food is prepared without salt. If the patient does not have high blood pressure, edema, heart failure, he is given 2-3 g of salt on his hands.
Due to the risk of developing hyperkalemia in a patient with ESRD, it is recommended to limit the amount of potassium administered with food to 2500 mg per day. Limit the amount of phosphorus introduced with non-protein foods (legumes, red cabbage, mushrooms, etc.), as well as dairy products containing a significant percentage of calcium and phosphorus, since the increased content of these minerals contributes to the development of renal osteodystrofipus.
The diet of patients with ESRD who are on regular hemodialysis should contain 0.75-1 g of protein per 1 kg of body weight per day. The amount of protein in the diet also depends on the number of hemodialysis per week: with an increase in the time of hemodialysis to 30 hours per week, it is necessary to increase the protein quota to 1.2 g/kg. The amount of vitamins in the diet should correspond to their physiological norm, the content of ascorbic acid should be increased to 250 mg per day. Patients with ESRD are recommended diet No. 7g.
Chemical composition and calorie content of diet No. 7g. Proteins 60 g (of which 3/< животного происхождения), жиров 110 г, углеводов 450 г. Калорийность 3000 ккал.
Vitamin content: retinol - 1.55 mg, karotype - 4.96 mg, thiamine - 1.34 mg, riboflavin - 2.5 mg, nicotinic acid - 13.44 mg, ascorbic acid - 250 mg. The content of minerals: potassium - 2542.5 mg, calcium - 624.5 mg, magnesium - 301.6 mg, phosphorus - 1192.7 mg, iron - 22.3 mg. Content in the daily diet of 45 g of animal protein, which is introduced in the form of meat, eggs and fish, provides the body with an optimal amount of essential amino acids. The calorie content of the diet is provided by fats and carbohydrates.
Great attention should be paid palatability diet. A variety of products are recommended, fresh vegetables and fruits, gourds (cucumbers, tomatoes, new potatoes, apples, plums, watermelon, etc.), the addition of spices, acidic vegetable and fruit juices (lemon, plum, apple, cherry, tomato, etc.). ). However, due to the possibility of developing hyperkalemia, strict control over the amount of fruits and vegetables consumed is necessary. fresh vegetables, and some of them are prohibited (apricots, bananas, dried fruits, legumes, etc.).
The amount of free fluid is limited to 700-800 ml, with anuria up to 300-400 ml.
The daily set of products included in diet No. 7g is presented in Table.
Table 78
Daily set of products included in the diet No. 7g (gross)
Product name | Product weight, g | Product name | Product weight, g |
| White bread salt-free | 100 | Flour | 10 |
| Tomatoes | 45 | ||
| Salt-free black bread | 100 | fresh cucumbers | 40 |
| Green pea | 35 | ||
| Meat or fish | 100 | Apples | 250 |
| Egg | 120 (2.5 pcs.) | Cabbage | 160 |
| Carrot | 40 | ||
| Milk | 140 | Beet | 50 |
| Sour cream | 140 | Onion | 8 |
| Cottage cheese | 25 | tomato paste | 10 |
| Butter | 40 | Green onion | 10 |
| Vegetable oil | 35 | Greenery | 15 |
| Sugar | 60 | Parsley | 5 |
| Potato | 300 | Honey | 50 |
Culinary processing. All dishes are prepared without salt. Meat and fish are given boiled or fried, which reduces the amount of extractives.
Flour and cereal dishes are limited due to their high vegetable protein content.
Eating fractional (6 times a day).
List of recommended foods and dishes for patients with terminal uremia on hemodialysis.
Salt-free white and black bread (200 g per day).
Soups. Vegetarian soups with various vegetables, borscht, beetroot, fresh vegetable soup with herbs and roots (250 ml) without salt, fruit soups.
Meat and poultry dishes. Low-fat varieties of beef, veal, chicken, turkey, rabbit, tongue, boiled or followed by baking and frying. Minced meat or a piece (55 g per day).
Fish dishes. Different types of fish instead of meat, boiled or fried.
Dishes and side dishes from vegetables. Potatoes, white cabbage, cauliflower, lettuce, tomatoes, fresh cucumbers, beets, greens. Vegetables boiled or fried. Allowed in kind.
Dishes and side dishes from cereals and pasta are limited, are used in the form of pilaf with fruit, casseroles, boiled for garnish.
Snacks. Vegetable and fruit salads, vinaigrette without pickles.
Eggs and dishes from them. Whole soft-boiled eggs, omelettes, for cooking other dishes (2-3 per day).
Dairy products and dishes from them are limited. It is allowed to roll up to 200 g per day, cottage cheese in the form of pudding or casseroles.
Fruits, berries, sweet dishes and sweets. Fruits and berries are best raw, as well as baked or boiled. Sugar, honey, jam.
The drinks. Tea, weak coffee, rosehip broth, raw fruit juices.
Sauces and spices. Milk sauce, sauce on sour cream, cream, water. Sweet and sour vegetable and fruit sauces. Horseradish, mustard, pepper, vinegar, cinnamon, cloves in limited quantities.
Fats. Butter and vegetable oil. Refractory fats are excluded.
Restricted: scoop currants, cherries, melons, peaches, pineapples, rhubarb, raisins, currants, figs, prunes, red cabbage, celery, mushrooms, chicory.
Forbidden: spicy, salty foods. Meat and fish broths, mushroom broths. Canned snacks, sausages, smoked meats, chocolate. Dried fruits, apricots, legumes,
Approximate one-day diet menu No. 7g (2950 kcal)
Name of dishes | Yield, g | Proteins, g | Fats, g | Carbohydrates, g |
| First breakfast | ||||
| Soft-boiled egg (2 pcs.) | 96 | 10,2 | 10,9 | 0,5 |
| Vegetable Salad | 150 | 4,0 | 11,4 | 18,0 |
| Kissel | 200 | 0,2 | - | 46,1 |
| Lunch | ||||
| baked apple | 120 | 0,4 | - | 29,3 |
| Dinner | ||||
| Vegetarian borscht with sour cream (1/3 norm) | 250 | 2,15 | 6,76 | 12,69 |
| Boiled meat | 55 | 16,0 | 3,2 | - |
| Fruit jelly (lemon) | 125 | 2,9 | - | 20,0 |
| afternoon tea | ||||
| Fruit mousse with swelling starch | 140 | 0,4 | - | 53,3 |
| Dinner | ||||
Zrazy potato with | 160 | 6,3 | 14,5 | 43,0 |
| Sour cream | 100 | 2,1 | 28,2 | 3,1 |
| Kissel | 200 | 0,2 | - | 46,1 |
| For the night | ||||
| Rosehip decoction | 200 | - | - | - |
| All day | ||||
| White achloride bread | 150 | 12,4 | 1,2 | 78,8 |
| Sugar | 40 | - | - | 39,8 |
| Butter | 20 | 0,12 | 16,5 | 0,18 |
| Honey or jam | 50 | 0,2 | - | 38,85 |
| Total | 61,0 | 101,6 | 451,8 |
The method of differentiated use of dietary nutrition in patients with chronic renal failure and end-stage renal failure. The appointment of low-protein diets for patients with chronic renal failure and the duration of their use are determined by the degree of renal failure. With a glomerular filtration rate of more than 40 ml / min, significant protein restrictions are usually not required, since these patients tolerate fairly significant protein loads - 60-80 g of protein (1 g / kg of body weight) quite well. With a decrease in glomerular filtration to 30 ml / min, it is necessary to limit protein in the diet to 40 g (i.e., 0.5 g / kg), which gives a completely satisfactory therapeutic effect. It should be borne in mind that 30 g of protein in the diet must be of animal origin (egg white, cottage cheese, boiled meat), vegetable proteins(bread, potatoes and other vegetables, cereals, fruits) should be only 10 g. In case of significant proteinuria, the protein content in food increases according to this loss (for every 6 g of urine protein, one chicken egg).
A dietary ration containing 30 g of animal protein can be used in any hospital. On an outpatient basis, patients with chronic renal failure can slightly expand the dietary regimen, increasing the proportion of protein to 60 g, while using ordinary food.
With a decrease in glomerular filtration in patients with chronic renal failure to 15 ml / min, the protein content in the diet is reduced to 20 g per day (0.25-0.3 g / kg) (diet No. 7a), and all this amount should be animal protein. Quite satisfactory results of treatment can be obtained from the use of this diet with a filtration rate of about 10-5 ml / min. Only when glomerular filtration is less than 4-3 ml / min is it necessary to transfer patients to hemodialysis with appropriate dietary recommendations.
The main therapeutic diet for most patients with chronic renal failure is diet number 7b, containing 40 g of protein. This diet is well tolerated by patients and can be used for a long time both in the hospital and on an outpatient basis.
The disappearance of uremic symptoms and the decrease in the level of nitrogenous wastes in the blood occurs faster when using diet No. 7a containing 20 g of protein than diet No. 7b. The content of urea and residual nitrogen in the blood serum also decreases faster when diet No. 7a is prescribed. However, in patients receiving this diet, as dyspeptic disorders disappear, the feeling of hunger gradually increases and weight loss is noted. Therefore, Diet No. 7a cannot provide a positive nitrogen balance with prolonged use.
The most adequate diet for long-term use in renal patients is diet No. 7b. Only with advanced renal failure, treatment should begin with diet No. 7a, and then, as the condition of patients improves, transfer them to diet No. 7b, against which you can periodically use diet No. 7a in the form of "zigzags". The duration of the appointment of diet No. 7a is determined individually, but it is applied no more than 25 days.
When transferring a patient with terminal uremia to hemodialysis, he is prescribed diet No. 7g.
List of products recommended for transfers from home to patients with chronic renal failure. Fruit juices: orange, grape, cherry, pomegranate, tangerine, peach, plum, cherry, apple and others at the rate of 400 g per day.
Fruits and gourds: quince, pineapples, oranges, pears, grapes, cherries, wild strawberries, strawberries, raspberries, lemons, tangerines, peaches, plums, red and black currants, cherries, apples, as well as watermelon and melon at the rate of 100-120 g of fruit and 300-350 g of melons per day.
List of products recommended for transfer from home to patients with end-stage renal disease on regular hemodialysis. Fruit juices: apple, plum, cherry, cherry, tomato, carrot at the rate of 150-200 g per day.
Fruits and gourds: apples, plums, lemons, cherries, pears - 120 g; watermelon, melon at the rate of up to 300 g per day.
Vegetables: tomatoes, cucumbers, etc. up to 200 g per day.
Reception of fruit juices, fruits and vegetables must be alternated.
Therapeutic nutrition for nephrotic syndrome
Nephrotic syndrome - kidney damage with massive proteinuria, hypo- and dysproteipemia, widespread edema, hypercholesterolemia and other disorders. In approximately 76% of patients, the cause of nephrotic syndrome is glomerulonephritis, in other cases - amyloidosis, diabetic nephropathy, nephropathy of pregnancy, circulatory failure, etc.Dietary therapy is built taking into account the characteristics of the pathogenetic mechanisms of the disease. Against the background of the use of corticosteroid drugs, cytostatics and immunosuppressants, to compensate for a significant loss of protein, diet No. 7c is prescribed with a high protein content, a sharp restriction of table salt (sodium ions), a liquid enriched with lipotropic factors (methionine, phosphatides), while fully providing the body with vitamins, minerals substances and trace elements.
Diet number 7c
Indications for appointment. Various chronic kidney diseases, amyloidosis, tuberculosis, rheumatism and collagenosis, accompanied by nephrotic syndrome.Special purpose. Replenishment of protein loss, reduction of hypoproteinemia, dysproteinemia and hypercholesterolemia, reduction of domestic syndrome and proteinuria.
General characteristics of the diet. A sharp restriction of table salt (only 2-3 g contained in products), extractives, liquids (up to 800 ml of free liquid), an increase in protein content (1.6 g / kg), mainly due to egg, milk and fish protein, full provision of the body's needs with minerals, vitamins and microelements, the exclusion from the diet of substances, drinks and products that irritate the kidneys (alcohol, nitrogenous extractives, cocoa, chocolate, spicy, salty snacks), the inclusion of vegetable oils in the diet (1/3 of the total amount of fat), methionine and phosphatides, which have a lipotropic effect.
Chemical composition and calorie content of the diet. Proteins 125 g (including 80 g of animals), fats 80 g (of which 25 g of plant origin), carbohydrates 450 g (refined 50 g), salt 2-3 g (in products). Calorie 2900 kcal.
Vitamin content: retinol - 0.95 mg, carotene - 11.7 mg, thiamine - 0.7 mg, riboflavia - 1.1 mg, nicotinic acid - 17.5 mg, ascorbic acid - 100 mg. The content of minerals: potassium - 3000 mg, calcium - 600 mg, magnesium - 285 mg, phosphorus - 1220 mg, iron - 21 mg.
Free liquid 800 ml. The mass of the diet is 2.5 kg. The temperature of the niche is normal, the number of meals is 5-6 times a day.
An approximate one-day diet menu No. 7c is presented in Table.
List of recommended products and dishes.
Bread and bakery products. Bread bran, wheat, white, salt-free.
Vegetarian soups with cereals, vegetables, fruit are cooked without salt.
Meat and poultry dishes. Lean beef, sweepips, lamb, chicken, turkey, rabbit boiled or fried, cut or minced.
Fish dishes. Low-fat fish (perch, perch, roach, pike, navaga, cod) boiled chopped or in pieces.
Dishes and side dishes from cereals and pasta. Semolina porridge, rice, wheat, buckwheat, pearl barley, etc. on water, milk, crumbly; krupeniki, puddings, zrazy, Pilaf, meatballs.
Dishes and side dishes from vegetables. Potatoes, carrots, beets, pumpkins, zucchini, cauliflower, tomatoes, cucumbers, lettuce, parsley. Boiled, baked, pureed, mashed.
Egg dishes. Bolkovy smlet and for cooking various dishes (more than 2 pieces per day).
Milk and dairy products and dishes from them. Whole milk, kefir, curdled milk, cottage cheese (low-fat) in its natural form, cottage cheese pudding, lazy dumplings.
Sauces and spices. White sauce, tomato sauce, marinade sauce, vegetable. Sweet and sour vegetable and fruit sauces with the exception of meat, fish and mushroom broths. Prepared with water, milk, sour cream, cream.
The drinks. The tea is not strong. Raw fruit and vegetable juices. Rosehip decoction.
Fats. Any, with the exception of refractory (mutton, beef, pork).
Approximate one-day diet menu No. 7c (2674 kcal)
Name of dishes | Yield, g | Proteins, g | Fats, g | Carbohydrates, g |
| First breakfast | ||||
| Omelette, stuffed with meat, steam | 150 | 18,2 | 13,6 | 3,1 |
| Marinated Krill Paste (without salt) | 180 | 11,0 | 17,6 | 13,8 |
| Tea with milk | 200 | 1,4 | 1,7 | 2,25 |
| Lunch | ||||
| Prunes | 50 | 0,9 | - | 32,8 |
| Dinner | ||||
Vegetarian barley soup with vegetables | 250 | 1,5 | 2,4 | 13,4 |
Meatballs baked in sour cream | 110 | 20,9 | 14,9 | 16,8 |
| Carrots stewed with prunes | 190 | 3,3 | 13,5 | 38,6 |
| fresh apples | 100 | 0,3 | - | 11,5 |
| afternoon tea | ||||
| Rosehip decoction | 100 | - | - | - |
| Dinner | ||||
| Stuffed fish | 85/150 | 17,3 | 10,1 | 7,0 |
| Steam pudding from fat-free cottage cheese | 150 | 16,9 | 6,7 | 34,3 |
| Tea without milk | 100 | |||
| For the night | ||||
| Kefir | 200 | 5,6 | 7,0 | 9,0 |
| All day | ||||
| White bread | 100 | 7,9 | 1,9 | 52,7 |
| bran bread | 150 | 14,7 | 7,2 | 54,5 |
| Sugar | 30 | - | - | 29,9 |
| Total | 120,0 | 96,8 | 319,4 |
Sweet dishes, sweets, fruits, berries, gourds. Any fruits and berries without restriction in raw and boiled form. Watermelon, melon, pumpkin. Sugar is limited to 50 g (you can use honey instead - 70 g).
Excluded: turnip, radish, sorrel, spinach, garlic.
Therapeutic nutrition for phosphaturia
Phosphaturia is characterized by a violation of the acid-base balance towards alkalosis and loss in urinary tract insoluble calcium phosphate. The development of phosphaturia is associated with a violation of the ratio of calcium and phosphorus in the urine as a result of an increase in the excretion of calcium in the urine and the loss of acidic valences by the body. However, with phosphaturia there is a complex chain of neurohumoral-renal disorders.Sodium and potassium phosphates are soluble in urine, which is both acidic and alkaline; calcium and magnesium phosphates in alkaline urine are insoluble.
Treatment for phosphaturia focuses primarily on acidifying the urine and limiting calcium-rich foods. It is necessary to exclude spicy snacks, spices, alcohol that excite the nervous system, and substances that are an active causative agent of the secretory function of the stomach from the diet if phosphaturia is accompanied by gastric hypersecretion.
Recommend a diet with a restriction of dairy and vegetable food and a predominance of meat food, flour dishes, with a sufficient content of vitamins (A p D) and plenty of fluids. The diet can include weak tea without milk or weak coffee with a small amount of cream, bread, eggs and egg dishes in limited quantities, butter and vegetable, meat, fish, meat or fish soups in all forms, flour dishes in all forms ( with excess body weight are limited). Fish (non-spicy) snacks are allowed, not very salty herring, canned fish in a small amount. From greens and vegetables, only those varieties that are poor in calcium and alkaline valencies (peas, Brussels sprouts, asparagus, pumpkin) can be included in the diet. Berries and fruits are limited (lingonberries, red currants, sour apples are recommended), products from sweet dough allowed in small quantities.
A long-term restriction of calcium compounds in the diet negatively affects the metabolism, therefore, against the background of the main diet in the form of a “zigzag”, you can periodically include calcium-containing foods (vegetables, fruits, greens) in the diet.
Therapeutic nutrition for oxaluria
Oxaluria is the persistent excretion of calcium oxalate crystals in the urine. The disease is associated with impaired excretion by the kidneys of protective coddoids that normally maintain oxalic acid in a dissolved state. Calcium onsalates fall out at any urine pH, more often at 5.4-6.6.When building a diet for patients with oxaluria, it should be borne in mind that the introduction of foods rich in oxalic acid with food increases the excretion of oxalates in the urine. Foods with an excess content of oxalic acid and its salt are excluded from the diet: sorrel, spinach, beets, potatoes, beans, rhubarb, figs, parsley, some berries (plums, strawberries, gooseberries), tea, cocoa, coffee, chocolate. The source of oxalic acid formations can be gelatin due to the content of 16-19% glycocol in it.
The removal of oxalates from the body is facilitated by apples, pears, quince, pear leaves, grapes, black currants (in the form of a decoction). Decoctions prepared on the peel of fruits enhance the excretion of oxalic acid from the body.
The diet of a patient with oxaluria includes the following products: white and black bread, animal and vegetable butter, milk, cottage cheese, sour cream, eggs, sour dairy products, cheese, vegetarian soups (from permitted vegetables and fruits), milk soups, meat, fish and poultry in boiled form in limited quantities (150 g every other day), dishes from cereals and dough, cauliflower and white cabbage, lentils, peas, green peas, turnips, asparagus, cucumbers, apples, pears, apricots, peaches, grapes, dogwood, quince.
A patient with oxaluria is allowed to introduce a sufficient amount of liquid (up to 2 liters) and juices of fresh vegetables and fruits. Somewhat restrictive diet table salt and carbohydrates. Patients with oxaluria can be recommended diet No. 5 with a restriction of carbohydrates to 300 g. During an exacerbation of the disease, it is necessary to limit the inclusion in the diet of milk and dairy products containing a significant amount of calcium.