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

* Fermentable Fibre suitable for those with kidney problems:

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

2. 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)

3. 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.

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