1. Diet therapy for acute nephritis
There are many kinds of glomerulonephritis with complicated clinical manifestations. The principle of diet therapy should be determined according to the degree of renal function and proteinuria of patients. Attention should also be paid to the edema and blood pressure of patients. After comprehensive analysis, we should determine how to eat diet.
Limit the onset of acute glomerulonephritis to 3-6 days in protein. The decrease of glomerular filtration rate will produce transient azotemia. Therefore, protein's diet should be restricted, and high-quality protein foods, such as milk, eggs, lean meat and fish, should be selected within the restricted range. When the condition improves, the urine volume increases, and the daily urine volume is >; When the dosage is 1000ml, the intake of protein can be gradually increased. However, it shall not exceed 0.8 g/kg body weight per day.
Low-salt and low-sodium diet edema and hypertension patients should adopt low-salt and salt-free diet. Low-salt diet generally uses 3 grams less salt or 10- 15 ml soy sauce every day. All salty foods should be avoided, such as pickles, pickles, eggs, preserved eggs, bacon, seafood, dried noodles and so on. Salt-free diet means cooking without salt or soy sauce, and can be seasoned with sugar, vinegar, sesame sauce and tomato sauce.
Limit foods with high potassium When oliguria, anuria or hyperkalemia occur, limit vegetables and fruits with high potassium content, such as soybean sprouts, leeks, green garlic, celery, cauliflower, Toona sinensis, spinach, bamboo shoots, lilies, dried red dates, fresh mushrooms, laver, pickled mustard tuber, Sichuan winter vegetables, mushrooms, apricots, lotus roots, sorghum, corn, lentils, and so on. The intake of liquid should be controlled according to the daily urine volume of patients. The general supplement method is to supplement the same amount of liquid as the urine discharged the day before, and then ingest 500~ 1000 ml of liquid. If the urine volume is low or accompanied by edema, the daily fluid intake should not exceed 1000 ml.
Patients with acute glomerulonephritis who are given proper calories and fat should stay in bed. The calories should not be too high, and the fat content in the diet should not be too high. The oil rich in polyunsaturated fatty acids is the main one, that is, vegetable oil is the main one.
Supply adequate vitamins Due to the restriction of foods containing more potassium, the intake of vegetables and fruits will be reduced, and the intake of vitamins will be significantly reduced, which will easily lead to vitamin deficiency. Various vitamin preparations should be supplemented, especially vitamin C, which should not be less than 300 mg per day.
2. Chronic nephritis and scientific diet
There are three main nutrients in food, namely protein, fat and carbohydrate. Protein is the main factor affecting kidney disease. However, protein is an essential nutrient for human body. If it is lacking, it will cause malnutrition, low immunity and bad health. Therefore, it is necessary to adjust the intake of dietary protein according to patients' different conditions. It is generally believed that patients with chronic nephritis with normal renal function should take a normal amount of protein, that is, per kilogram of body weight per day 1 gram. When renal insufficiency occurs, protein's intake is limited, generally limited to about 0.6 grams per kilogram of body weight per day. Protein should not be over-restricted to avoid malnutrition. Within the limited protein intake, priority should be given to high-quality protein foods, such as milk, eggs, fresh lean meat and fish. Non-quality plant proteins such as tofu and bean products in protein are not inedible, but their proportion should not exceed one third of the total kg intake in protein.
The so-called high-quality protein refers to protein which contains a variety of essential amino acids. Renal insufficiency often seriously lacks essential amino acids and must be supplemented. However, just food supplements, even foods containing the most essential amino acids? For example, eggs contain 46.2% and milk contains 44.8%? Supplement, it is difficult to meet the needs. Therefore, when limiting the intake of protein, attention should be paid to supplementing the pharmaceutically necessary amino acids or their derivatives. Shenyantong, also known as Kaitong or Compound α -keto acid, is an ideal drug for patients with renal insufficiency. This medicine can not only supplement amino acids necessary for nutritional therapy, but also delay the progress of renal function damage caused by low-protein diet.
In addition to the low-protein diet and the treatment of essential amino acids, it is also necessary to ensure that the food eaten every day has enough calories. This can be achieved by appropriately increasing carbohydrates in the diet, such as wheat starch, lotus root starch, sugar, vegetable oil and so on. It is best to reach 65,438+046.5 kilojoules per kilogram of body weight per day (65,438+06.74 kilojoules per gram of carbohydrate and protein, and 37.7 kilojoules per gram of fat), so as to ensure that the ingested protein can be fully utilized by the body to synthesize its own protein (when the heat is insufficient, protein will be oxidized into fuel to generate heat, just like carbohydrates and fat, which cannot be decomposed into amino acids for reuse).
It is best for patients' families to buy a food ingredient list from the bookstore to learn more about the protein, carbohydrate and fat content of various foods, so as to help patients arrange their daily meals.
In addition, if patients with chronic nephritis have hypertension or (and) edema, it is also important to limit the intake of salt, which can reduce the retention of water and sodium in the body and is conducive to blood pressure reduction and diuresis. Generally, it is advisable to consume about 3 grams of salt every day.
3. Diet conditioning of pyelonephritis
Pyelonephritis is a purulent inflammation caused by bacteria invading the renal pelvis, renal calices and renal parenchyma. Generally speaking, pyelonephritis and ureteritis are upper urinary tract infections, while urethritis and cystitis are lower urinary tract infections. Pyelonephritis is often associated with lower urinary tract inflammation. The disease mainly occurs in women, and the ratio of male to female is 1∶ 10, especially in elderly women and men. Acute pyelonephritis usually occurs suddenly, accompanied by fever, chills, headache, nausea, vomiting, general pain, dull or sore waist. The main symptoms are urgency, frequent urination and dysuria. Most patients with chronic pyelonephritis have a history of recurrent attacks or prolonged healing, and their clinical manifestations are different. They may have symptoms of urinary tract irritation at the onset, no symptoms or only mild symptoms at the intermission, and serious damage to renal parenchyma may occur at the later stage, resulting in hypertension, anemia, polyuria, nocturia, acidosis and even uremia. Urine laboratory examination shows hematuria, and there are a lot of white blood cells or pus cells in urine.
(1) dietary principles
1. During the acute attack of acute pyelonephritis and chronic pyelonephritis, you should stay in bed and drink plenty of water, and the daily drinking amount should be more than 2500ml, so as to increase the urine volume and promote the rapid discharge of bacteria, toxins and inflammatory secretions.
2. Adjust the pH value of urine. Sulfonamide and aminoglycoside antibiotics have enhanced antibacterial effect in alkaline urine, so you can eat more alkaline food or sodium bicarbonate (baking soda); However, tetracycline, furandine and other drugs have enhanced antibacterial effect in acidic urine, and acidic food can be eaten or a large amount of vitamin C can be taken orally to acidify urine.
3. The diet should be light and easy to digest.
4. Provide rich nutrition, including sufficient calories, sufficient supply of high-quality protein and vitamin A, vitamin B 1, vitamin B2, vitamin C, etc.
(2) Examples of recipes
Breakfast: golden silk rolls (50 grams of flour, eggs 10 grams)
Millet noodle porridge (50g millet noodle)
Baked tofu with sherry red (tofu100g, sherry red 50g)
Meal: orange juice 200 ml lunch: rice (rice 150 g).
Stir-fried bean sprouts (mung bean sprouts100g)
Roast beef with potatoes (beef100g, potatoes 50g)
Laver soup (laver10g, Chinese cabbage leaf 20g)
Meal addition: 50 grams of soybean milk crystals are made into 200 ml drinks.
Dinner: steamed stuffed bun (flour 100g, lean pork 30g, Chinese cabbage 100g).
Mixed tomato (tomato 100g, sugar 10g).
Spinach tofu soup (50 grams of spinach and 50 grams of tofu)
20 grams of cooking oil for a whole day.
The daily heat energy is about 9030 kilojoules (2 150 kilocalories).
(3) the main points of food selection
1. Acidic foods include squid, fish floss, chicken, carp, meat, laver, peanuts, rice and flour. Alkaline foods include Undaria pinnatifida, kelp, mushrooms, spinach, soybeans, chestnuts, bananas, rape, carrots, potatoes, radishes, fruit juice, milk and tofu. Besides, tea and coffee are also alkaline foods.
2. Soups or drinks should be properly added to the recipe to ensure adequate water intake.
4. Nursing care of pyelonephritis
"Pyelonephritis" is urinary tract inflammation caused by direct bacterial infection. Bacteria can rise from the urethral orifice and enter the renal pelvis and kidney through the bladder and ureter.
Pyelonephritis can be divided into acute pyelonephritis and chronic pyelonephritis. Acute can be transformed into chronic if not treated in time; Chronic diseases can also cause acute attacks due to factors such as treatment or rest. This disease is more common in women, especially women of childbearing age. Clinical manifestations: sudden onset, fever, chills, backache, frequent urination and urgency. Routine examination often shows that urine contains a large number of pus cells, white blood cells and red blood cells, with little proteinuria. Bacteria can be found in urine culture.
Nursing points:
1, encourage patients to drink more water and increase urine output.
2, regular urine test and training, grasp the condition.
3. Women should pay attention to sexual life, menstrual period and pregnancy hygiene.
4. Pay attention to the cleanliness and sterility of diapers during the baby girl period.
5. If the patient's fever still does not go down or rise after treatment, those with severe low back pain need to be sent to hospital for treatment.
Key points of home care:
1. Pay attention to maternal and child health care. Women should keep their vulva clean and use bath lotion carefully. Menstrual period, pregnancy and baby should pay special attention to hygiene to prevent upward infection. Women with acute pyelonephritis should take contraceptive measures within one year after treatment to avoid pregnancy and aggravate the condition.
2. Acute pyelonephritis or chronic pyelonephritis should drink more water during acute attack, and the daily intake should be more than 2500 ml. Objective To increase urine output and promote the excretion of bacteria, toxins and inflammatory secretions. At the same time, we should pay attention to strengthening nutrition and physical exercise.
3. Observe whether there are symptoms of fever and urinary tract irritation. In the late stage of chronic pyelonephritis, pay attention to whether there are symptoms of renal damage, such as hypertension, anemia and uremia.
4. After drug treatment, pay attention to whether the drug has side effects, such as nausea, vomiting and loss of appetite caused by oral drugs, and ask the doctor before switching to other drugs for treatment.
5. If you need to do urine culture, you should make the following preparations.
① Urine samples should be collected before using antibiotics or 5 days after stopping using antibiotics.
② Collect morning urine. Ensure that the urine stays in the bladder muscle for 6 ~ 8 hours.
③ Before taking a urine sample, the perineum should be thoroughly cleaned to avoid urine contamination. When leaving urine, take the middle urine and put it in a sterile test tube.
(4) Keep the urine sample well, and do culture and colony counting within two hours to avoid the breeding of miscellaneous bacteria and affect the judgment result.
If there are special circumstances, urine should be refrigerated in the refrigerator below 4℃.
6. Pay special attention to avoid catheterization or urine test to prevent infection.
5. Dietary care of patients with nephrotic syndrome
Patients with nephrotic syndrome have clinical symptoms such as hypoalbuminemia and high edema. Therefore, some patients have some misconceptions about diet adjustment. Some patients think that there is too much protein lost in urine, and they must eat a lot of protein to supplement the loss in the body; Some patients are afraid to eat protein and only eat some vegetables every meal, thinking that this can reduce the leakage of urine protein. In fact, both views are one-sided. Excessive intake of protein will increase the burden on the kidneys, while insufficient intake of protein will not maintain normal physiological needs.
For patients with nephrotic syndrome, the daily intake of protein should be determined according to the loss of protein in urine. Generally, the daily intake should be 1.5-2.0g/kg body weight, and a high-quality and high-protein diet such as meat, eggs, milk and fish is preferred.
If the patient has azotemia, the intake of protein should be limited, the daily intake of protein should be kept as low as possible, and the daily supply of protein should be limited to about 50g.
As for salt supplement, we should also give a low-salt, salt-free or sodium-free diet according to the degree of edema. If the edema is not serious, the daily supply of sodium is about 2000mg, which should also include the sodium content in food. It is allowed to add 2-3 g of salt or soy sauce10-15 ml every day during cooking. For those with obvious edema, the daily sodium supply should be limited to 1000mg, and salt or soy sauce should not be added during cooking; For patients with high edema, the total daily sodium supply is limited to 500 mg.
It is worth pointing out that although salt is the main source of sodium, some foods with high sodium content in the diet, such as beef jerky, beef floss, shrimp skin, sea cucumber, preserved eggs, salted duck eggs, instant noodles, fried dough sticks, pickled mustard tuber, laver and potherb mustard, should also be avoided.
In addition, patients with nephrotic syndrome should be provided with a certain amount of heat (adult daily 126- 147 kj/kg body weight) and some trace elements such as calcium and iron, as well as probiotics A, D, B2, C, etc. The intake of lipid substances should be limited, and the diet with less oil and low cholesterol is better. At the same time, seafood, shrimp, crab, pickles, sweet noodle sauce, fermented bean curd, bacon, sausage, bacon and other fatty and salty foods, tobacco, wine, vinegar and other irritating foods, garlic, leeks, onions and other spicy foods should also be avoided. It's best to eat something light every day.
With the development of blood purification treatment, the dietary restrictions of dialysis patients are gradually relaxed, and some people even think that the dietary restrictions of dialysis patients can be completely relaxed. However, dialysis treatment can not replace the renal function of healthy people 100%. Take creatinine clearance rate as an example. At present, the most efficient dialyzer can not achieve the function of normal kidney. So at present, it is absolutely necessary to restrict and guide the diet of dialysis patients.
In addition, according to the survey of Japanese Dialysis Society, so far, diseases closely related to diet such as heart disease, cerebrovascular disorder, hyperkalemia and malignant constitution are still the main causes of death of dialysis patients. Therefore, it is generally believed that proper guidance and restriction on the diet of dialysis patients can not only improve the quality of life of dialysis patients and prolong their lives, but also reduce the pressure of clinical dialysis treatment.
In Japan, dialysis diet education must be conducted twice or three times (about 1 hour each time) for patients and their families who start dialysis treatment, and repeated education must be conducted for patients and their families who do not pay attention to their diet. Speaking of dietary guidance and education for dialysis patients, let's first look at the difference between normal kidney and artificial kidney.
Normal renal function
1) Remove wastes and harmful substances from the body.
2) Adjust water and electrolyte to balance acid-base toxicity.
3) Adjust blood pressure
4) promoting erythropoiesis
5) activate vitamin d (promoting calcium absorption)
Artificial kidney (dialyzer)
1) Remove wastes from the body.
2) Adjust the electrolyte and acid-base balance of body fluids.
In addition, normal kidneys work continuously for 24 hours, while dialysis is once every 2 to 3 days to forcibly remove waste accumulated in the body for several hours. At the same time, it is difficult for dialyzer to remove high molecular weight substances, which leads to peripheral nerve dysfunction, abnormal skin pigment, abnormal sugar and fat metabolism and so on.
The guiding principles of dialysis diet mainly include the following points:
1) protein-take a proper amount of high-quality protein.
2) Calories-Take in enough calories (save protein consumption in the body).
3) Water and salt-a lot of dehydration during dialysis will increase the burden on the cardiac circulatory system.
4) Potassium-hyperkalemia is the cause of cardiac arrest, so fruits and vegetables should be treated with potassium removal.
5) Phosphorus-Persistent high blood phosphorus will cause bone softening, so it is necessary to control phosphorus intake.
High-quality protein refers to high-priced protein rich in amino acids and histidine needed by human body, such as eggs, meat, fish, shellfish, milk and dairy products. Excessive intake of protein leads to the increase of blood urea nitrogen. According to the report of FAO/WHO/United Nations University, the appropriate daily intake of protein for normal adults is 0.75g/kg body weight. The principle of controlling water and salt is self-evident. However, due to the salty diet in China, especially in northern China, and the accumulation of harmful substances in dialysis patients, the thirst of patients is aggravated. Therefore, it is often reported that they gained more than 5 kilograms between dialysis. In this way, the dialysis dehydration setting has to be set above 5kg, which leads to the fluctuation of body weight and increases the burden on the cardiac circulatory system. In addition, the accumulation of salt in the body will also cause hypertension, which will bring bad prognosis to patients. Because the control of potassium and phosphorus is related to other nutrients, we cite an example of the dietary intake standard of dialysis patients 1 day in combination with the nutritional needs of adults:
(1) heat:
Rice or noodles, steamed bread 200gX3, oil 20g, sugar 20g. Because the daily calorie intake of patients with renal failure is above 35 kcal/kg body weight, if this standard is not met, the intake of staple food can be increased.
(2) protein (related to phosphorus intake)
Meat: 70g/ day fish: 70g/ day, eggs: 50g/ day.
Milk: 100g/ day Limit beans: 50g/ day.
(3) Fruits and vegetables (related to potassium intake):
50 grams of taro/day, 50 grams of fruit/day, 250 grams of vegetables/day. Although the recommended daily salt intake of normal people is about 10g, the daily salt intake of renal dialysis patients, including patients with advanced renal disease, should not exceed 5g. It is difficult to calculate the daily potassium intake, which is generally controlled at 1.300 ~ 1.800mg.
6. dialysis and diet
With the development of blood purification treatment, the dietary restrictions of dialysis patients are gradually relaxed, and some people even think that the dietary restrictions of dialysis patients can be completely relaxed. However, dialysis treatment can not replace the renal function of healthy people 100%. Take creatinine clearance rate as an example. At present, the most efficient dialyzer can not achieve the function of normal kidney. So at present, it is absolutely necessary to restrict and guide the diet of dialysis patients.
In addition, according to the survey of Japanese Dialysis Society, so far, diseases closely related to diet such as heart disease, cerebrovascular disorder, hyperkalemia and malignant constitution are still the main causes of death of dialysis patients. Therefore, it is generally believed that proper guidance and restriction on the diet of dialysis patients can not only improve the quality of life of dialysis patients and prolong their lives, but also reduce the pressure of clinical dialysis treatment.
In Japan, dialysis diet education must be conducted twice or three times (about 1 hour each time) for patients and their families who start dialysis treatment, and repeated education must be conducted for patients and their families who do not pay attention to their diet. Speaking of dietary guidance and education for dialysis patients, let's first look at the difference between normal kidney and artificial kidney.
Normal renal function
1) Remove wastes and harmful substances from the body.
2) Adjust water and electrolyte to balance acid-base toxicity.
3) Adjust blood pressure
4) promoting erythropoiesis
5) activate vitamin d (promoting calcium absorption)
Artificial kidney (dialyzer)
1) Remove wastes from the body.
2) Adjust the electrolyte and acid-base balance of body fluids.
In addition, normal kidneys work continuously for 24 hours, while dialysis is once every 2 to 3 days to forcibly remove waste accumulated in the body for several hours. At the same time, it is difficult for dialyzer to remove high molecular weight substances, which leads to peripheral nerve dysfunction, abnormal skin pigment, abnormal sugar and fat metabolism and so on.
The guiding principles of dialysis diet mainly include the following points:
1) protein-take a proper amount of high-quality protein.
2) Calories-Take in enough calories (save protein consumption in the body).
3) Water and salt-a lot of dehydration during dialysis will increase the burden on the cardiac circulatory system.
4) Potassium-hyperkalemia is the cause of cardiac arrest, so fruits and vegetables should be treated with potassium removal.
5) Phosphorus-Persistent high blood phosphorus will cause bone softening, so it is necessary to control phosphorus intake.
High-quality protein refers to high-priced protein rich in amino acids and histidine needed by human body, such as eggs, meat, fish, shellfish, milk and dairy products. Excessive intake of protein leads to the increase of blood urea nitrogen. According to the report of FAO/WHO/United Nations University, the appropriate daily intake of protein for normal adults is 0.75g/kg body weight. The principle of controlling water and salt is self-evident. However, due to the salty diet in China, especially in northern China, and the accumulation of harmful substances in dialysis patients, the thirst of patients is aggravated. Therefore, it is often reported that they gained more than 5 kilograms between dialysis. In this way, the dialysis dehydration setting has to be set above 5kg, which leads to the fluctuation of body weight and increases the burden on the cardiac circulatory system. In addition, the accumulation of salt in the body will also cause hypertension, which will bring bad prognosis to patients. Because the control of potassium and phosphorus is related to other nutrients, we cite an example of the dietary intake standard of dialysis patients 1 day in combination with the nutritional needs of adults:
(1) heat:
Rice or noodles, steamed bread 200gX3, oil 20g, sugar 20g. Because the daily calorie intake of patients with renal failure is above 35 kcal/kg body weight, if this standard is not met, the intake of staple food can be increased.
(2) protein (related to phosphorus intake)
Meat: 70g/ day fish: 70g/ day, eggs: 50g/ day.
Milk: 100g/ day Limit beans: 50g/ day.
(3) Fruits and vegetables (related to potassium intake):
50 grams of taro/day, 50 grams of fruit/day, 250 grams of vegetables/day. Although the recommended daily salt intake of normal people is about 10g, the daily salt intake of renal dialysis patients, including patients with advanced renal disease, should not exceed 5g. It is difficult to calculate the daily potassium intake, which is generally controlled at 1.300 ~ 1.800mg.
7. Dietary taboos of kidney disease
1, you should eat light and digestible food, and avoid seafood, beef and mutton, spicy food, wine and all hair products such as spiced aniseed, coffee and coriander. ; Especially for patients with yin deficiency, such as: red tongue, heavy pulse, night sweat, dry stool, hematuria and other symptoms; However, patients with yang deficiency, such as pale tongue with white fur, heavy pulse, cold body and limbs, loose stool, eating heat.
2. Eat fresh fruits and vegetables and drink water properly; Avoid all tonics, tonics and foods that are easy to get angry, such as peppers, lychees and chocolates. It is especially suitable for patients with blood stasis such as purple tongue, pulse stagnation, chest tightness, abdominal distension and so on.
3. All patients with nephropathy are forbidden to inject neomycin, streptomycin, gentamicin, Akebia manshuriensis and active immunization.
4, uremia patients keep defecation unobstructed, it is advisable to defecate 2∽3 times a day, don't stay up late, control sexual life, pay attention to rest and avoid catching a cold.
5. Those who have taken hormone should reduce the dose and frequency of hormone under the guidance of a doctor according to the specific situation.
6. People with severe edema should avoid salt, limit food intake in protein and drink less water. If edema is not serious, you can enter a low-sodium diet; No edema, no restriction on drinking water and protein food intake; Microscopically, people who have hematuria and get angry should drink more water and eat more foods such as apples, sugar, black sesame seeds and fungus to nourish yin and reduce fire.
7. People with uremia and hyperkalemia should not eat high-potassium foods, such as bananas, oranges, potatoes, tomatoes, pumpkins, tea, soy sauce, monosodium glutamate, etc. On the contrary, patients with hypokalemia.
8. People with high blood uric acid should not eat animal viscera, fish, shrimp, crabs, clams, beer, mushrooms, beans and spinach.
9. During the treatment, if you have a cold, fever, infection, etc. Contact a specialist in case of emergency so as to deal with it in time and avoid aggravating complications.