1. Medical Nutritional Therapy For Renal Diseases & Gout

2. Objectives Nice to know the relative definitions, kidney function, pathophysiology, hidden sources of sodium, high sod. Foods, high oxalate foods, high purine foods. Must know the medical nutritional therapy goals, MNT of; nephrotic syndrome, chronic renal failure, gout,

3. Kidney Function: Filters & reabsorbs essential blood constituents. Maintain fluid, electrolytes, acid-base balance. Eliminate waste products, &many drugs. Manufacturing hormones to maintain BP (renin). Stimulate RBC production. Regulate Ca &P metabolism. Nephritic Syndrome: Damage of capillary walls of glomerulus leads to proteinuria, hypoalbuminemia, hyperlipidemia &edema. It is caused by secondary diseases; glomerulonephritis, nephropathy secondary to amyloidosis, DM, SLE, or infectious diseases. Treated with steroids & immunosuppressant, but s.t. not respond & pass to chronic renal failure.

4. MNT goal : Control hypertension Minimize edema Decr. urinary alb. losses Prevent protein malnutrition& muscle catabolism Supply adequate energy Slow the progress of renal disease. MNT: Adequate protein 0.8-1gm/kg/d to avoid catabolism. Energy ≥35Kcal/kg/d, to avoid malnutrition. CHO 50-60%of total caloric intake..

5. Fat up to 30% of total caloric intake, mainly monounsaturated &PUFA to decrease the risk of hyperlipidemia. Limited dietary sodium to control HT & edema, avoid canned& processed foods, hidden sources of sodium; water, baking powder, toothpaste & mouth wash, medication( antacid, antibiotics, cough medicine, laxatives, pain killers, sedatives). High sod. Foods; olives, salted nuts, salad dressings, ketchup, sauce, potato chips, popcorn, processed meat, tuna, all cheese (except low sod.), canned veg., tomato juice.

6. Chronic Renal Failure Result from progressive, irreversible loss of kidney function, &pass to end stage renal disease ESRD. It can be caused by; glomerulonephritis, nephrosclerosis, obstructive diseases ( R.S., tumors, congenital birth defects), DM, SLE, abuse of analgesics. CRF cause retention of nitrogenous waste products, fluid & electrolytes imbalance which affect all the systems. Management goals : focus on slowing the progression of CRF to ESRD by; reducing uremia by either conservative management, hemodialysis, peritoneal dialysis, or renal transplantation.

7. It is important not only to design food combinations that include the necessary nutrients, but it should be acceptable &the patient enjoy it, it depends on the method of treatment in addition to medical & nutritional status of the patient.  Dietary modification should be initiated as early as possible to minimize uremic toxicity,  Delay the progression of renal disease (limit food toxic byproducts)  Prevent wasting & malnutrition (adequate calories to prevent tissues catabolism),  Motivation & encouragement to the patient if he feel that’s difficult to follow.

8. Medical Nutritional Therapy:  Reduce protein &phosphorous to minimum requirements to slow the progression of renal insufficiency,(Protein should be of high biological value).  Sodium 2000mg/d  Potassium 2000mg/d.  Phosphorous 1000mg/d.  Fluid 1000ml/d. Add spices like garlic or onion to enhance the flavor for the allowed foods.

9. Gout Hereditary abnormal metabolism of purines, cause a form of acute arthritis, with inflamed joints (usually knees& feet). Hyperuricemia results with deposition of urate& s.t. sodium. MNT goals: -Weight loss for obese patient. -Increase urates excretion. -Force fluid intake to prevent uric acid stones. -Correct any existing hyperlipidemia.

10. Dietary recommendations (MNT): 1-High CHO diet& low fat intake increase excretion of urates. 2- In acute case; avoid excessive intake of purines( shellfish, smoked meat, sardines & meat extracts). 3-Exclude alcohol beverages. 4-Calorie controlled diet for obese. 5-Ensure high fluid intake.

11. Foods high in purines High: content 150-825mg/100g *Shellfish, seafood, sardines. *Meat, brain, kidney, liver. Moderate: content 50-150mg/g *Vegetables; cauliflower, green peas, mushrooms, spinach *Grains& legumes; peas, lentils, beans, *Oatmeal, wheat bran, whole grain breads & cereals. *Fish; all kind, lobsters, oysters.

12. *Meat; beef, lamb *Poultry; chicken, duck, turkey. Low: content 0-50mg/100g *Beverages; carbonated beverages, coffee, tea. *Grains; bread& cereals (refined white flour) *Dairy; cheese, milk (all fat levels) *Miscellaneous; eggs, fat, fruits& juices, gelatin, nuts, sugars& sweets, vegetables.