Chronic Kidney Disease Case Study

Here is a case study for Mrs Smith:

Age 62y

CKD3a

Hypertension

Insulin Resistance

 PERSONAL GOALS:

  • Prevent further kidney damage from occurring
  • Improve blood values to within normal limits, especially:
    • Urea
    • Creatinine
  • Reduce proteinuria
  • Improve energy levels, through stabilizing blood glucose (sugar) levels
  • Lose weight and body fat percentage
Dietary GoalPractical Comment
Eat regular meals3 small meals: B, L, S
+ 3 small snacks
Have water in-between meals and snacks
Carbohydrates:
- low GI (avoid high GI)
Include at each meal and snackLow GI foods eaten every 3-4 hours will sustain blood glucose and thus energy levels, thereby speeding up metabolism.
Mostly exclude all refined starches and high sugar foods
Fibre:
40g fermentable fibre / day
Include a source of fermentable fibre at each meal and snack
 4-5 servings of fruits and veg/day
NB: see *list of good sources of fermentable fibre below.
Lowers urea, creatinine
Reduces inflammation
Proteins: 50g protein/day
(1 Protein portion = 7g protein  see Exchange List)
Spread throughout the day as per suggested menuLean: remove fat from meat, skin from chicken
Low fat cooking methods
Fats:
- minimize intake of all high fat foods
- use small amounts of mono-unsaturated fats
Monounsaturated fats include: olive / canola oil; olives; avocado

Read food labels: <5g fat/serving
Avoid animal fats (fat on meat, skin on the chicken)

Use low fat cooking methods: grill / steam / stir-fry / casserole
Salt (sodium): use sparingly
1500mg sodium/day
Use a little / none in cooking;
none at table
Avoid processed foods and canned foods and sauces due to high salt/sodium content
Supplements:
- Multivitamin & multi-mineral

- Omega-3
StaminoGro/Food-State / Centrum

Optimega / Food-State Omega-3
/day


3 capsules/day
Water: 2l / dayThroughout day
Exercise2-3 x/week

* Fermentable Fibre suitable for those with kidney problems:

Fruits Vegetables Starches Legumes Other (K free)
ApplesBrussel sproutsItalian breadChickpeasMetamucil
PearsBeetrootPumpernickelLentilsFybogel
CherriesBroccoliRye breadKidney beansAIM Herbal Fibre Blend
PlumsCabbageProvitasButter beans
Prunes– freshCauliflowerPita breadSoy beans
GarlicOats, rye, wheat
LeeksPuffed wheat
PeasPotatoes
OnionsSweet potatoes
Pasta

The Kidneys

Our 2 kidneys do many jobs, including:

  • Eliminating waste products, like urea, from the body
  • Regulating fluid balance in the body
  • Producing 3 hormones that
    • a) regulate blood pressure
    • b) prevent anaemia
    • c) help to make and keep the bones strong (Vitamin D)

Normally functioning kidneys make urine – which contains fluid and other waste products.  These waste Products come from PROTEIN (found in foods such as meat, eggs, dairy products, also in smaller Quantities in starch & veg).

When a person develops kidney disease, certain problems can be caused:

  • The kidneys fail to get rid of waste products adequately in the urine, and the subsequent UREA build-up in the blood can cause one to feel nauseous
  • Anaemia
  • Blood pressure can increase
  • Bone disease can be caused due to:
    • a) PHOSPHOROUS not being eliminated in the urine, and it’s subsequent build-up in the blood
    • b) the hormone Vitamin D, not being produced
  • POTASSIUM (K+) is not efficiently eliminated in the urine, and can also build-up in the blood – which can be dangerous to the heart
  • SODIUM is also kept in a delicate balance by the kidneys. Excesses in the body are eliminated in the urine when the kidneys are functioning normally. A build-up in the blood causes thirst.

Lab values to watch out for:

Blood test                              Reference range

Albumin                                 35 – 50 g/L

Calcium                                 2.3 – 2.8 mmol/l

Creatinine                              44 – 97 umol/l

Carbon dioxide                      23 – 31 mmol/l

Cholesterol                            < 4.9 mmol/l

Iron                                         13 – 31 umol/l

Magnesium                           0.6 – 1.0 mmol/l

Phosphorous                         0.97 – 1.45 mmol/l

Potassium                             3.5 – 5.0 mmol/l

Sodium                                  136 -145 mmol/l

Urea                                       2.5 – 6.7 mmol/l

GFR                                        > 60ml/min/1.73m²

Urine analysis:

U – Protein                            0 – 0.15g / 24h

U – albumin                           0 – 0.1g / 24h

Extra info: Potassium, Phosphorous and Sodium 

  1. POTASSIUM (NB: not increased in your case, but still we need to be a little cautious with intake)
  • A mineral found in all foods.
  • Some foods contain large amounts of potassium, eg oranges, dried fruits, nuts, milk, melon, potatoes, avocado, salt substitute, beans and legumes.
  • If potassium is not excreted in the urine, due to inadequate kidney function – it builds up in the blood à this is dangerous to the heart
    • may cause weakness, nausea, tingling in toes and fingers, diarrhoea, difficulty breathing
    • but often there are no symptoms linked with high potassium levels
  1. PHOSPHOROUS (NB: also not increased : no need to limit at this point)
  • Working kidneys remove excess phosphorous from the blood and excrete it in the urine.
  • When the kidneys are not functioning adequately – excess phosphorous builds up in the blood:
    • may cause itching, red eyes, calcium loss from the bones, and deposits of phosphorous and calcium in soft tissues such as skin, muscles, and the heart
  • High blood phosphorous levels have to be controlled by DIET and MEDICATION (PHOSPHOROUS BINDERS, eg B-Cal)
  1. SODIUM (definitely limit now already, even though blood values are not increased. By reducing intake, you will prevent blood pressure from increasing, and so protect your kidneys!)
  • When referring to salt (a chemical compound called sodium-chloride) – it is the SODIUM that we are concerned about
  • Sodium is also removed via the kidneys. When the kidneys are not working properly, sodium builds up in the body.
  • Excess sodium can cause thirst, water retention, high blood pressure, swelling in the feet and legs, puffy eyelids, and difficulty in breathing.
  • It is preferable to LIMIT / AVOID sodium.

SUGGESTED MENU

MEALFOOD GROUPPORTIONSDAY 1ALTERNATIVE
BREAKFASTSTARCH24 Ryvita 50g Soya Life porridge + water
PROTEIN1Cottage cheese1 boiled egg
FAT22tsp salt-free butter2tsp salt-free butter
MIDMORNINGDAIRY½125ml low fat plain yoghurtSoya Life Instant meal replacement drink
FRUIT21 banana2 plums
LUNCHSTARCH22 slices Best of Both bread1 large seed roll
PROTEIN180g tofu / salmon30g cooked chicken
VEG A1SaladSalad
FAT22tsp lite margLow oil mayo
16H30FRUIT21 pear1 apple
SUPPERSTARCH21 cup rice and lentils2 slices seed bread
PROTEIN260g cooked chicken curry2 portions baked fish
VEG A1SaladBroccoli
VEG B1½ cup carrots½ cup peas
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