The basic principle of dietary guidelines for nephropathy is "five lows and one high", that is, low fat, low salt, low protein, low potassium, low phosphorus and high cellulose. However, the decline degree of glomerular filtration rate in patients with different stages of nephropathy is different, and the specific principles followed are also different. It is generally recommended that patients with kidney disease always maintain a good habit of low-salt and low-fat diet. Patients with massive proteinuria should adhere to the principle of high quality and low protein diet in the early stage. In the middle and late stage, kidney friends should pay attention to reducing the intake of food containing phosphorus and potassium.
This dietary principle emphasizes eating less, but does not explain the balanced collocation of daily diet nutrition, which leads some patients to blindly diet and dare not eat more, resulting in insufficient nutrition intake, and some people even dare not drink more water, which is not conducive to the stability of the disease and even aggravates the disease.
The elderly with renal failure drink less water and strictly control their diet, but their condition gets worse and the index is stable after TCM conditioning.
Case: Patient xxx, male, 60 years old, with chronic kidney disease for 5 years. At first, he didn't care. Later, drug treatment improved, but it recurred many times. The serum creatinine increased in March of 20 16, and it was diagnosed as chronic renal failure. In addition to taking medicine, patients have been strictly controlling their diet. Because I heard that drinking too much water will increase the burden on the kidneys, I seldom drink water, hardly eat meat, only eat vegetables and eat less oil and salt. Long-term light diet makes them emaciated, and mental illness and kidney disease are obviously improved.
In May of 20 18, physical symptoms became worse. Knowing that Chinese medicine can regulate the body, I went to a hospital in Beijing for medical treatment, hoping to improve my condition through Chinese medicine. At the time of initial diagnosis, the waist is sore and the legs are weak, the whole body is weak, dizziness and tinnitus, dry mouth and throat, fever in hands and feet, red tongue, thin tongue coating and thready pulse. Renal function examination showed that the serum creatinine value was 303 umol/L.
Syndrome differentiation of traditional Chinese medicine is: deficiency of kidney-qi, hyperactivity of fire due to yin deficiency and turbid toxin. Traditional Chinese medicine treatment should benefit qi and nourish yin, tonify kidney and drain turbidity. Chinese medicine experts choose Chinese medicine prescriptions: Radix Rehmanniae, Radix Rehmanniae Preparata, Tortoise, Rhizoma Anemarrhenae, Radix Astragali, Radix Angelicae Sinensis, Radix Codonopsis, Radix et Rhizoma Rhei, Radix Achyranthis Bidentatae and Radix Ophiopogonis. One dose a day, decocted in water. Auxiliary diet conditioning, especially in summer, drink water in moderation. If you drink too little water, your body will be short of water, which will affect the formation of urine, which is not conducive to waste excretion and the stability of your condition. And the nutrition should be balanced. If you don't eat meat for a long time, malnutrition will also occur.
After taking 1 month, symptoms such as fatigue, backache and tinnitus disappeared and appetite returned to normal. The creatinine value of renal function is 214 umol/L. After taking the original prescription for 2 months, there is no discomfort, increased appetite, stable sleep and improved spirit. The creatinine value of renal function was 92 umol/L, and all indexes were normal. Since then, I have always insisted on Chinese medicine conditioning and reasonable diet. Follow-up for 3 years showed that the serum creatinine was stable at 90~ 140, and he lived a normal life, doing housework and neglecting physical labor.
How do kidney patients drink water?
The renal function of patients with nephropathy has been damaged, so their metabolic ability will also decrease. Drinking too much water may increase the burden on the kidneys, but drinking less water is not good for your health.
1, early nephropathy, take the initiative to drink water. Many people feel thirsty before they want to drink water. In fact, at this time, the body is already in a state of water shortage. If you stay in this state for a long time, it will inevitably cause liver and kidney damage. Patients with early renal disease should take the initiative to drink water, drink plenty of water and drink more times to ensure the patency and cleanliness of the renal system. This way of drinking water is far better than drinking a lot of water at once.
2, kidney disease oliguria, edema, drink water according to urine volume. Nephropathy patients have edema and oliguria, so we should pay attention to adjust the amount of drinking water. Generally speaking, adults drink 500 ml of water, including drinking water, soup, porridge, infusion and so on. On the basis of urinating the day before. It's best not to drink.
3, kidney disease without urine, dialysis, drink water according to weight changes. Patients with severe kidney disease usually have anuria and dialysis. At this time, it is necessary to strictly adjust the amount of drinking water according to your own situation. In particular, patients with kidney disease who need hemodialysis should pay more attention to controlling the amount of drinking water. If you are really thirsty, you can't gulp water. You can choose ice cubes or fruit pieces, and you can also relieve thirst symptoms by gargling.
How do patients with kidney disease eat? Reasonable dietary nutrition
1, protein is indispensable for kidney disease. Low protein diet is one of the basic dietary principles of nephropathy. For patients with a large amount of urinary protein, it is often emphasized to reduce the intake of high-protein food appropriately. But excessively reducing protein's diet can cause hypoproteinemia. Studies have shown that long-term adherence to a high-protein diet (daily protein intake exceeding 1.5g/kg) will lead to glomerular filtration, increase the expression of inflammation and increase the risk of inflammatory reaction in the kidney. Another study shows that a proper low-protein diet can contract the afferent arterioles of glomerulus and reduce the intraglomerular pressure, thus reducing the renal filtration pressure and urinary protein leakage.
No matter at which stage of nephropathy, patients with impaired renal function should adhere to a low-protein diet (except uremia dialysis). And control the intake of protein according to the urine protein. In patients with glomerular filtration rate less than 45 ml/min/ 1.73 m2, the quantitative urine protein is less than 1g, the daily protein intake is 1-65438+3.5g/kg, and the quantitative urine protein intake is 0.8- 1 g/kg. However, after hypoproteinemia, malnutrition and loss of stable protein, the diet can be properly restored.
2, kidney disease micronutrient-potassium. Electrolyte disorder is easy to occur in the middle and late stage of nephropathy, which leads to hyperkalemia. The increase of potassium ion accumulation in blood not only causes hyperkalemia, but also causes other diseases, such as numbness of limbs, muscle weakness, slow heart rate, and even serious cardiac arrest, which is extremely harmful to the body. Patients with blood potassium greater than 5.5 mmol/L need a low potassium diet, especially those with renal failure and uremia. Mushrooms, beans and laver are the main vegetables with high potassium content in daily life, and yellow fruits such as bananas and oranges are the main fruits. When cooking, blanching can filter out some potassium, and the daily intake of fruits should be controlled and matched well.
3, kidney disease micronutrient-phosphorus. After renal function is substantially damaged, electrolyte metabolism is disordered, and phosphorus will increase obviously besides blood potassium accumulation. On the one hand, kidney disease causes the increase of parathyroid hormone level and thyroid hormone secretion, which leads to the increase of bone phosphorus release and blood phosphorus. On the other hand, the development of tubulointerstitial fibrosis leads to abnormal reabsorption capacity. Poor metabolism of blood phosphorus. The increase of blood phosphorus often affects the absorption of blood calcium, which is easy to cause osteoporosis and even fractures, and needs to be adjusted in time. Patients with renal insufficiency need a low-phosphorus diet, and the daily intake should not exceed 800 mg/day (26 mmol/day). Foods with high phosphorus content in daily life are mainly processed foods, such as drinks, nuts, seaweed and animal offal.
4. Sodium, an element that regulates the balance between water and sodium. Nephropathy will emphasize the need for a low-salt diet to reduce the metabolic burden of the kidneys and relieve the symptoms of hypertension and edema. The daily salt intake should not exceed 5g, and the patients with edema and hypertension should not exceed 3g. But many foods in daily life contain "invisible salt", which tastes salty but can't be seen, and needs to be converted into sodium.
Daily intake of 1g salt contains about 400mg of sodium. According to the controlled amount of salt intake, it is best for patients to consume no more than 2000mg(2g) of sodium every day. Strictly controlling the daily intake of sodium ions will help to relieve symptoms such as blood pressure, edema and urinary protein, ensure the blood supply to the kidney, stabilize the blood volume, improve the filtration function of glomerulus and prevent cardiovascular diseases caused by hypertension.