Kidney disease and diet therapy Prepared by Hanan G. Altawil Supervisor D. Baker M.Zabut

1. The Islamic University-Gaza Deanery of Higher Educatio Faculty of Science Department of Life Science Zoology الجامعـة الاسلاميـة- غـزةعمـادة الدراسـات العليـا كليـة العلـومماجستير العلـوم الحياتيـةعلم حيوان Kidney disease and diet therapy Prepared by Hanan G. Altawil Supervisor D. Baker M.Zabut 2008-م /1429 هـ

2. الغذاء في القران لكريم ”يَا أَيُّهَا الَّذِينَ آمَنُواْ كُلُواْ مِن طَيِّبَاتِ مَا رَزَقْنَاكُمْ وَاشْكُرُواْ لِلّهِ إِن كُنتُمْ إِيَّاهُ تَعْبُدُونَ“ (172)البقرة الغذاء ذكر في القران فى 52 سورة في 160ايهالاغذية النباتيةذكر العيديد من الاغذية النباتية كالزيتون زيت الزيتون النخيل الموز التين النبق الرمان الفواكه الخضر القمح البقل القثاء الفوم العدس البصل الحب الاغذية الحيوانيةذكر ايضا في العديد من الايات كالحوم الانعام والاسماك والسلوى واللبن وعسل النحل وما فيه من فائدة طبية عظيمة

3. الاغذية في الاحاديث النبوية • على سبيل المثال ذكر التمر و الثمرات من الاغذية النباتيةقال صلى عليه الله عليه وسلم منبها إلى أهمية التمر الغذائية " بيت لا تمر فيه جياع أهله" رواه مسلم وأحمد • اللحم اللبن السمك الكبد الطحال الجراد من الاغذية الحيوانيةعن النبي صلى الله عليه وسلم أنه قال: " أحلت لنا ميتتان ودمان : السمك والجراد والكبد والطحال" • عسل النحل وفوائدة العظيمة حيث يشجع على امتصاص الماء من الأمعاء بدون أن تزيد من امتصاص الصوديوم

4. هدى الإسلام في تناول الطعام والشراب • فقال عز وجل: ” وكلوا واشربوا ولا تسرفوا، إنه لا يحب المسرفين“ (31) الأعراف. • وقد وردت في السنة النبوية الأدلة الموجهة الى، فقال صلى الله عليه وسلم : " ما ملأ ابن آدم وعاء من شر من بطنه ، بحسب ابن آدم لقيمات يقمن أوده، فإن كان لا بد فاعل فثلث لطعامه وثلث لشرابه وثلث لنفسه" • وقال صلى الله عليه وسلم: "يأكل المسلم في معي واحد، والكافر يأكل في سبعة أمعاء".

5. EXCRETORY SYSTEM Each kidney has approx. 1 million nephons which are the “filtering units” of the kidney

6. Functions of the Kidney • Filters (cleanses) blood -Helps to maintain fluid, electrolyte balance in the body - Helps to maintain acid-base balance in the body - Eliminates metabolic wastes • Help to regulate blood pressure • Produces erythropoietin – stimulates red bloodcell production • Converts the inactive form of vitamin D into theactive form Filtration , Haemodynamic , Endocrine

9. Consequences of Kidney Disease • Increase in blood nitrogen levels • Increase in blood creatinine levels • Elevated blood electrolyte levels and fluid retention • Anemia – low hemoglobin & hematocrit • Low vitamin D levels low blood calciumlevelselevated parathyroid hormone • Loss of serum proteins – “leak out”through kidneys

10. The stages of kidney disease • Kidney damage with normal or high GFR 90 cc/min/1.73m² • Kidney damage with mild decreased GFR 60 – 89 cc/min/1.73m² • Moderately decreased GFR 30 – 59 cc/min/1.73m² • Severely decreased GFR 15 – 29 cc/min/1.73m² • Kidney Failure Less than 15 cc/min/1.73m²

11. Types of Kidney Disorders • Nephrotic Syndrome • Acute Renal Failure • Chronic Renal Failure • kidney stones

12. Nephrotic Syndrome • Nephrotic Syndrome – occurs when theglomerular capillaries malfunction and there is aloss of plasma proteins into the urine • Treatment: Diet Order is High Kcalorie, moderate protein, sodium, and fat-restricted – Energy -~35kcals/kg body wt – Protein – .,8 - 1gm/kg body wt. – Fat -<30% of total kcals – Sodium -<2grams/d – Medications – may be needed to decrease cholesterol and triglycerides, and also to lower bloodpressure

13. Acute Renal Failure • Acute Renal Failure – occurs when the nephrons suddenly losefunction and are unable to maintain homeostasis • Can develop when blood flow to the kidney suddenly declines (Prerenal( – Heart failure – Shock – Severe blood loss after surgery • Can develop due to an obstruction in the urinary tract (post-renal) • Can also develop when there is kidney cell damage (intra-renal) – Infections – Toxins – Drugs

14. Treatment of Acute Renal Failure • Main goal is to treat the underlying cause in order to prevent permanent or further damage tothe kidneys - Blood transfusion, dialysis, drug therapy, diet therapy • Diet Therapy – Energy –45-30kcals/kg; more may be needed toprevent further wasting and malnutrition – Protein -.,6-.,8g/kg (non-dialysis), 1,2 -1,3 g/kg(dialysis) - Fluids – measure urine output and add 500 ml of extra water; may need more water if dehydrated – Sodium – may need to restrict to 2 to 3 g/day

15. Some signs of Chronic kidney failure • Extreme tiredness • Nausea and vomiting • Shortness of breath • Difficulty sleeping • Swelling in the hands, face, and feet • Loss of appetite • Itchiness • High blood pressure

17. Some causes of kidney failure • Glomerulonephritis • Arteriosclerosis • Congenital abnormalities of urinary system • Obstructions of urinary system • Toxins • Polycystic kidney disease • Infection • Kidney stones • Trauma (physical injury(

18. Diet and medications are important treatments for kidney failure. In the early stages of kidney disease, simple diet changes can help you feel better. • Your nephrologist and dietitian will construct a diet to help preserve your kidney function. • Your nephrologist may also order medications to help problems such as blood pressure control and water removal

19. Diet and the Kidney • Progression of CRF • Control of Hypertension • Prevention of Complications Cardiovascular Renal bone disease • Nutrition

20. Diet and Renal Bone Disease in CRF • Low Phosphate 1000 mg/day • High Calcium + Calcium supplements Vitamin D

21. Diet and the Kidney • Protein low/high • Sodium low (60 mmol/d) • Potassium low (60 mmol/d) • Calcium high • Phosphorus low (1000 mg/d) • Lipids low

22. Nutrition in Kidney Diseases Prevalence of malnutrition in ESRD • Protein stores depleted 40% • Fat stores depleted 60% • Decrease body weight ~ 50%

23. Monitoring Nutrition in Kidney Disease Anthropometric measurements • Height • Weight • Body mass index • Mid arm circumference (MAC) • Triceps skin fold thickness (TSF) • Mid arm muscle circumference (MAMC)

24. Monitoring Nutrition in Kidney Disease Subjective Global Assessment (SGA) • Changes in food intake • Weight loss • Oedema • Muscle wasting • Functional changes • GI disturbances

25. Monitoring Nutrition in Kidney Disease Biochemical markers • Total protein • Albumin • Pre-albumin • Transferrin • Complement • Insulin-like growth factor-I

26. Nutrition in Kidney Disease Management • Increase nutrients intake • Provide soluble vitamins • Switch off Catabolism • Switch on Anabolism

27. Nutrition in Kidney Disease Increase Nutrients Intake • Optimise dialysis • Correct anaemia • Oral supplements • Parenteral supplements (IDPN)

28. Nutrition in Kidney Disease Switch off Catabolism • Correct metabolic acidosis • Control Microinflammation • Decrease Anabolic hormones resistance – Adequate dialysis

29. Nutrition in Kidney Disease Switch on Anabolism • Administer GH • Administer IGF1 • Combination of GH/IGF1

30. Recently in Japan they found that : • the long-term intake of diacylglycerol (DAG oil) prevented the progression of renal function in the subjects of type 2 diabetes with nephropathy, delaying the onset of dialysis.

31. Kidney Stones • Develop when stone constituents become • concentrated in urine (i.e. individual does • not drink enough fluids each day) • ~75% of stones are composed of calcium • oxalate • Some stones are composed of uric acid • )associated w/ gout), cystine, ormagnesium ammonium phosphate

32. Prevention of Kidney Stones • Drink plenty of fluids each day • Consume adequate dietary calcium • – Dietary calcium combines with oxalate in the • intestines . • reducing oxalate absorption • – Low calcium diets promote oxalate absorption • Limit foods high in oxalate • – Berries, chocolate, beets, spinach, rhubarb, • wheat bran, tea, nuts • Moderate intake of protein

33. Trivia: the record holder for kidney stones is Don Winfield of Ontario, Canada who produced and passed 4,504 stones in his lifetime; he eventually had to have this kidney removed!!

34. قال تعالى (قالوا سبحانك لا علم لنا الا ما علمتنا، انك انت العليم الحكيم) صدق الله العظيم