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Diet For Acute Renal Failure By Mumtaz Khalid Ismail
More Links Acute renal failure Causes of renal failure Symptoms of renal failure Dietary management of renal failure Deterioration of renal functions due to any cause may result in renal failure. Renal failure is of two types that depend up on the onset and characteristic presentations. They are acute and chronic renal failure. Dietary therapy is useful in the management of both these conditions.
This type of renal failure is characterised by rapid deterioration of renal function, resulting in accumulation of nitrogenous and other waste products and biochemical derangement. Most important clinical feature in majority of patient is not passing or severely reduced quantity of urine. If we take timely action derangement caused by acute renal failure can be reverted. Causes of acute renal failure are grouped as pre-renal (eg: acute gastroentritis, blood loss, shock, liver and heart failure etc.), renal (eg: glomerulonephritis, renal vein thrombosis, acute tubular nephritis etc.), and post renal conditions (eg: obstructive uropathy, neurogenic bladder ). By preventing dehydration you can prevent acute renal failure due to gastroenteritis.
Patients with acute renal failure have widely varying changes in metabolic and nutritional status. In patients with acute renal failure marked protein catabolism may accelerate the rate of rise in plasma concentration of potassium, phosphorous, nitrogenous metabolites and acids and may increase the risk of delayed wound healing. Dialysis may require in severe and prolonged cases of acute renal failure.
- Loss of blood from any causes including complications of pregnancy and delivery, ulcers, internal haemorrhage or gastrointestinal bleeding.
- Loss of plasma as in burns and crushes injuries.
- Loss of fluid in severe vomiting, diarrhoea, acute intestinal obstruction, paralytic items and fistulas, diabetic coma and additions disease.
- From the skin in excessive sweating.
- General anaesthesia and surgical operation reduce renal blood flow and may precipitate renal failure. In these whose blood volume is preciously balanced
- Serious infections especially septicaemia may produce shock and reduce renal blood.
- Acute haemolytic disorders.
- Nephrotoxins like paracetamol and mushrooms.
- Nephritis or nephrosis can result in acute renal failure.
- Renal vein thrombosis.
- Renal vasculitis.
- Acute tubular necrosis due to any cause.
- Obstructive uropathy.
- Neurogenic bladder.
- Low urine volume. The urinary out put may be as little as 20 - 200 ml per day.
- Lethargic, anorexic, nausea and vomiting.
- There may be elevation of blood pressure or low blood pressure.
- Accumulation of waste products of protein metabolism in blood. Serum urea nitrogen and creatinine levels are increased.
- Potassium excretion is diminished.
- Serum phosphate and sulphate are increased and sodium, calcium and base bicarbonate are decreased.
Dietary treatment is directed toward correction of fluid and electrolyte imbalance and maintenance of adequate nutritional status in order to minimise endogenous protein catabolism and subsequent uraemia.
- Energy
- A minimum of 600 - 1000 kcal is necessary. A higher calorie intake of carbohydrates and fats is desirable.
- Proteins
- Proteins containing foods are to be stopped if the patient is under conservative treatment and the blood urea nitrogen is rising. However 40 gm protein is allowed if the patient is on peritoneal dialysis or hemodialysis as it will reduce the endogenous protein breakdown and maintain health.
- Carbohydrates
- A minimum of 100 gm per day is essential to minimise tissue protein breakdown. Two litres of 5% glucose meets this. If patient is not fed by mouth a nasogastric tube feeding of 700 ml of 15 % glucose is administrated.
- Fluids
- The fluid allowance is regulated in accordance with the urinary out put, any additional losses from vomiting or diarrhoea and an allowance for insensible water looses. The total fluid permitted in 500 ml + previous days urine out put + total loss from the above causes.
- Sodium
- The dietary sodium allowance is based on frequent measurement of the sodium ion in serum and urine. For the non-dialysed patient restriction of sodium is necessary where as on dialysis patient's sodium intake is allowed.
- Potassium
- Potassium intoxication (hyperkalemia) occurs in acute renal failure. It has deleterious effects on heart. A bowel wash may remove 1000 mEq of potassium. Potassium rich sources such as tomato juice, coffee, tea, cocoa are avoided.
- Foods avoided
- High protein foods like pulses, milk and milk products, egg, fish, meat and poultry and nuts and potassium rich sources such as tomato juice, apricots, mango, peaches, drumstick, coffee, tea, cocoa are to be avoided. Sodium high food like tin food, Chinese food, pickle, papad, baking powder are also to be avoided.
- Hemodialysis or peritoneal
- Hemodialysis or peritoneal is considered in acute renal failure when blood urea level is over 200 mg %. The diet may then be raised to 2000- 3000 kcal and 40 gm of protein. During dialysis if the patient cannot take oral feeds, intravenous fat and amino acid infusion has to be given.
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