Case - A 50-year old Female having Hypertension since 15 years, had Chronic Kidney Disease(CKD), and has underwent Transplant.

1. Saba Kazi 151
Yashvi Mehta 154
Aasiya Shaikh 158
Alifa Shaikh 159
Khadijah Shaikh 163

2. HOW ARE HIGH BLOOD
PRESSURE AND KIDNEY
DISEASE RELATED?

3. High blood pressure is either a cause of CKD or a complication
High Blood Pressure
Damages blood vessels
Reduces blood supply to
important organs like kidneys
Damages the tiny filtering
units in kidneys
Kidneys stop removing wastes
and extra fluid from the blood
The extra fluid builds up in
blood vessels

4. Kidneys keep blood pressure In a healthy
range
Diseased kidneys are not able to regulate
blood pressure
Complications
As a result, blood pressure increases

5. C SE STUDY
A 50-year old Female having Hypertension since 15
years, had Chronic Kidney Disease(CKD), and has
underwent Transplant.

6. General
Information

7. Age: 50 years
Gender: Female
Occupation: Retired
Number Of Family Members: 5
Type Of Family: Joint

8. Food Habits: Vegetarian
(Jain)
Uses Cows Milk-Skimmed
Food Intolerance: None
Food Allergy: None
Meal Pattern: 5-6 meals

9. Lifestyle: Sedentary
Smoking and Alcohol Consumption: No
Physical Activity: None
Outside Food Intake: Occasionally
Sleeping Hours: 6-8 hours

10. Biochemical
Parameters

11. Creatinine 5.2 mg/dl
Electrolytes:
Sodium 135 mEq/L
Potassium 5 mEq/L
Blood Pressure 150/100 mmHg
Pre-Transplant report

12. Kidney Function Tests:
Creatinine 0.8mg/dl
BUN 10mg/dl
Fasting Blood Sugar 80mg/dl
Liver Function Tests
Albumin 3g/L
Kidney Ultrasound:
Both kidneys Normal is size.
No calculus or hydronephrosis
seen.
Recent reports

13. Anthropometric
measurements

14. Height: 160 cm
Weight: 60 kg
Ideal Body Weight (IBW): Acc. To Broca's Index (for Females)
IBW = Height(cm)- 105
= 160-105
= 55 kg
Body Mass Index (BMI)= weight(kg)
height(m²)
= 60
2.56
BMI = 23.4kg/m²
Ref: Krause’s Food and Nutrition Care Process,Edition 14

15. % Desirable Weight =
𝑪𝒖𝒓𝒓𝒆𝒏𝒕 𝑾𝒆𝒊𝒈𝒉𝒕 𝒌𝒈 −𝑰𝑩𝑾(𝑲𝑮)
𝑰𝑩𝑾(𝑲𝑮)
X 100
= 𝟔𝟎−𝟓𝟓
𝟓𝟓
X100
= +9.1%
Evaluation Of Weight Status = (Current Weight – IBW) kg
= (60 – 55) kg
= 5 kg overweight

16. Medications

17. Side effects: Itching, abdominal pain,
dry mouth, joint pain, swelling,
dizziness, changes in vision, chest pain,
back pain, headache, diarrhea

18. Side Effects: Fluid retention, liver
damage, tremor, tingling, swelling in
the face, pimples, gum swelling,,
infections and GI symptoms

19. 3 Day Diet
Recall

20. Day

21. Meal Menu Ing Exg.
Amt
(g)
Energ
y
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Early
Morning Tea
Skim
Cows
Milk 1 150 53 5.3 7.5 0.2 - -
6.30-
7am

22. Meal Menu Ing Exg.
Amt
(g)
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Break
fast Khakra
Wheat
flour 1 30 100 3.3 22 0.4 6 94
8.30-
9am Upma Rava 1 30 100 3.3 22 0.4 6 25
Curd-C 1 150 100 5 7 6 32 130
Tomato ¼ 25 - - - - 3.2 37
Fat 5 45 - - 5 - -

23. Meal Menu Ing Exg.
Amt
(g)
Energy
(kcal)
Protei
n
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Mid
morning Fruit Orange 1 100 50 - 10 - 4.5 93
10.30-
11am

24. Meal Menu Ing Exg.
Amt
(g)
Energy
(kcal)
Protei
n
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Lunch Roti
Wheat
Flour 1½ 45 150 5 33 0.6 9 141
1-2pm Rice Rice 1 30 100 2.1 23 0.2 2.4 20.4
Kadhi
Chana
Flour 1 30 100 7 17 0.5 21 216
Curd-C 1 150 100 5 7 6 32 130
Jaggery 5 20 - 5 - - -
Oil 5 45 - - 5 - -
Sabzi Bhindi 1 100 - - - - -

25. Meal Menu Ing Exg.
Amt
(g)
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Snack Tea
Skim
Cows
Milk 1 150 53 5.3 7.5 0.2 - -
5:00-
5.30pm Biscuits
Marie
Gold 4nos.

26. Meal Menu Ing Exg.
Amt
(g)
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Dinner Bhakri
Wheat
flour 1 30 100 3.3 22 0.4 6 94
8.30-9pm
Ragi
flour ½ 15 50 1.8 10 0.7 28 75
Besan
Chana
flour 1 30 100 7 17 0.5 21 216
Khichu
Rice
flour 1 30 100 2.1 23 0.2 2.4 20.4
Oil - 5 45 - - 5 - -

27. Meal Menu Ing Exg.
Amt
(g)
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Bedtime
Stewed
Fruit Apple 1 90 50 10
10.30-
11pm
Glass of
Milk
Skim
Cows
Milk 1 150 53 5.3 7.5 0.2
TOTAL 1514 60.8 250.5 31.5 173.5 1292

28. Day

29. Meal
time Menu Ing Ex Amt
Energy
(kcal)
Protein
(g)
CHO
(g) Fat(g)
Na
(mg)
K
(mg)
Early
Morning Khakra Wheat 1 30g 100 3.3 22 0.4 6 3.6
6:30-
7:00am Fenugreek 25g 12 1 1.5 19 7.7

30. Meal timeMenu Ing Ex Amt
Energy
(kcal)
Protei
n (g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Breakfast Tea
Skim Cow's
Milk 1 150ml 53 5.3 7.5 0.2
8:30-
9:00am Sugar 5g 20 5
Poha Riceflakes 1 30g 100 2.1 23 0.2 3.2 46.4
Tomato 0.25 25g 3.2 36.5
Oil 5g 45 2
Sugar 5g 20 5

31. Meal time Menu Ing Ex Amt
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Mid
morning Nuts Almonds 1 15g 100 3 4 8
10:30-
11:00am

32. Meal
time Menu Ing Ex Amt
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Lunch Roti Wheat 1 30g 100 3.3 22 0.4 6 3.6
1:00-
2:00
pm
Sabji Capsicum 25g
Tomato 25g 3.2 36.5
Fat 5g 45 5
Vaghar
rice Rice 1 30g 100 2.1 23 0.2 2.4 20.4
Peas 0.5 25g 25 1.8 2 6.1 218
Fat 5g 45 5
Dal Tur dal 1 30g 100 7 17 0.5 8.5 331
Fat 5g 45 5
Sugar 5g 20 5

33. Meal
time Menu Ing Ex Amt
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Snack Khakra Wheat 1 30g 100 3.3 22 0.4 6 3.6
5:00-
5:30pm Fruit Apple 1 90g 50 10 25.2 67.5

34. Meal
time Menu Ing Ex Amt
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Dinner Thepla Wheat 1 30g 100 3.3 22 0.4 6 3.6
8:30-
9:00pm Fenugreek 25g 12 1 1.5 19 7.7
Curd 0.5 75g 27 2.7 3.7 0.1
Fat 5g 45 5
Moong Moong 1 30g 100 7 17 0.5 8.4 253
Tomato 0.25 25g 3.2 36.5
Fat 5g 45 5
Pineapple
Sheera Semolina 1 30g 100 3.3 22 0.4 6.3 25
Fat 5g 45 5
Sugar 8g 32 8
Dinner Thepla Wheat 1 30g 100 3.3 22 0.4 6 3.6

35. Meal Menu Ing Exg.
Amt
(g)
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Bed
time
Warm
Milk
Skim
Cow's
Milk 1
150
ml 53 5.3 7.5 0.2
10:30-
11:00 Sugar 5g 20 5
TOTAL 1659 55.8 255.7 43.9 131.7 1100.6

36. Day

37. Meal Menu Ing Exg.
Amt
(g)
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Early
Morning Tea Milk 1 150 100 5 7 6 109 210
6:30am-
7:00am Sugar 5 20 - 5

38. Meal Menu Ing Exg.
Amt
(g)
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Break-
fast Dhokla
Chana
flour 1 30 100 7 17 0.5 21 216
8:30-
9:00
am oil 5 45 5
Date and
tamarind
Chutney

39. Meal
time Menu Ing Ex Amt
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Mid
Morning
Fruit
and nut Apple 1 90 50 10 28 75
10:30am-
11:00am Walnuts 1 15 100 3 4 8 - -

40. Meal
time Menu Ing Ex Amt
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Lunch Roti
Wheat
flour 1 30 100 3.3 22 0.5 6 94
1:00p
m-2pm
Tinda
sabzi
Ragi 0.5 15 50 1.6 11 0.2 6 5
Dal Tur dal 1 30 100 7 17 0.5 8.5 331
Oil 5 45 5
Sugar 5 20 5
Rice Rice 1 30 100 2.1 23 0.2 2.4 20.4

41. Meal Menu Ing
Exg
.
Amt
(g)
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Snack Khakra
Wheat
flour 1 30 100 3.3 22 0.4 6 94
5:00pm-
5:30pm Fruit Banana 1 50 50 10 36 88

42. Meal Menu Ing Exg.
Amt
(g)
Energy
(kcal)
Protei
n
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Dinner
Oats
Muthiya Oats 1 30 100 5 20 2.1
8:30-
9:00
pm Semolina 0.5 15 50 1.7 11 0.2 3 12
Curd 1/4 30 25 1.3 1.8 1.5 8 32

43. Meal Menu Ing Exg.
Amt
(g)
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
Bed time
Masala
milk Milk 1 150 100 5 7 6 109 210
10:30-
11pm Nuts 0.5 8 50 1.5 2 4
TOTAL 1534 46.8 199.8 45.1 366.5 1425

44. 1756
1759
1534
Average of Recall (kcal)
Day 1 (Sun)
Day 2 (Mon)
Day 3 (Tue)
1683 kcal
(Energy)
Avg: 57.1 g
(13.7%)
(Protein)
249.9 g
(60.4%)
(CHO)
46.9 g
(26%)
(Fat)

45. Interpretation of Recall
The patients Sodium Intake is high
There is high intake of Fat

46. Medical
Nutrition Therapy

47. To Provide adequate nutrients
To Provide Complex Carbohydrates
To Provide High Biological Value Protein
To Provide Good Quality Fats
To Restrict Sodium Intake and Increase Potassium
To Provide Nutrients rich in Antioxidants
To Provide a Neutropenic diet

48. Dietary Guidelines
Energy- According to weight status the patient should be given
sufficient calories to achieve IBW
CHO- Complex Carbohydrates to be given
Proteins- High Biological value protein from egg, milk, curd, paneer
should be given to promote healing process
Fats- Good Quality Fat to be given. MUFA and Omega 3 sources.
Anti-Oxidant foods- As after Kidney Transplant patient is put under
immunosuppressants, food sources rich in antioxidants to be
given to decrease oxidative stress

49. Sample Diet Plan
IBW- 55kgs
BMI- 23.4 kg/m2
Energy : 30kcal/kgIBW = 30x55 = 1650kcal
Protein : 15% of total calories = 248kcal = 62g
CHO : 55% of total calories = 907kcal = 226.8g
Fat: 30% of total calories = 495kcal = 55g
Sodium: 2500mg

50. Food Exchange
List

51. Food Exc
No. of
Exc
Amt
(g)
Cost
(Rs)
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Na
(mg)
K
(mg)
CEREALS 5 19 516 15.9 109.8 3.3 18.1 229.8
Rice 2 60g 8 200 4.2 46 0.4 4.8 40.8
Wheat Flour 2 60g 6 200 6.6 44 0.8 12 189
Oats 1 30g 5 116 5.1 19.8 2.1 1.3 -
PULSES 1 ½ 5 150 10.5 25.5 0.7 23 296.7
Lentil 1 30g 3 100 7 17 0.5 12 188.7
Chana Flour ½ 15g 2 50 3.5 8.5 0.2 11 108
NUTS 1¼ 6.2 125 3.8 5 8.2 - -
Groundnuts 1 15g 3 100 3 4 8 - -
Walnuts ¼ 4g 3.2 25 0.8 1 0.2 - -

52. Food Exc
No. of
Exc
Amt
(g)
Cost
(Rs)
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat (g)
Na
(mg)
K (mg)
MILK &
MILK PDS
3¼ 37.9 254 18.8 16.5 12.8 248.3 441.5
Curd-C ¾ 112ml 7.9 75 3.8 5.2 4.5 24 97.5
Paneer 1 40g 14 100 7 - 8 60 29
Skim Milk 1 ½ 225ml 16 79 8 11.3 0.3 164.3 315
VEG A ¾ 11.2 - - - - 30.5 240
Tomato ½ 50g 6.2 - - - - 6.5 73
Spinach ¼ 25g 5 - - - - 24 167
VEG B 1¾ 18 88 6.4 13.5 - 30.7 170
Peas 1 ½ 75g 12 75 5.4 12 - 11.7 118.5
Fenugreek ¼ 25g 6 13 1 1.5 - 19 51.5

53. Food Exc
No. of
Exc
Amt
(g)
Cost
(Rs)
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat (g)
Na
(mg)
K
(mg)
FRUITS 2 18 100 - 20 - 132 416
Musk Melon 1 150g 8 50 - 10 - 104 341
Apple 1 90g 10 50 - 10 - 28 75
FATS AND
OILS
24g 24g 4 216 - - 24 - -
SUGAR 19g 19g 2 76 - 19 - - -
MISC.
Tender Corn 1 100 15 100 3.2 19 1.2 - -
TOTAL Rs. 136.3 1650 60.3 231.3 50.2 482.6 1794
RDI 1650 62 226.8 55 2500 -
DIFFERENCE - -1.7 4.5 -4.8 - -

54. Sodium Intake
Sodium Intake through Diet= 482.6
Salt Intake Allowed= 2500-482.6
= 2017.4
= 2017.4
400
= 5 g

55. Ideal Distribution
of Nutrients/meal

56. Meal % of total Calories
Energy
(kcal)
Protein
(g)
CHO
(g)
Fat
(g)
Ideal
Distribution
Plan
Distribution 1650 60.3 231.3 50.2
Early Morning 5% 4.4% 83 3 11.6 2.5
Breakfast 25% 24.8% 412 15.1 57.8 12.6
Mid-Morning 5% 5.1% 83 3 11.6 2.5
Lunch 25% 24.5% 412 15.1 57.8 12.6
Snack 10% 10.1% 165 6 23.1 5
Dinner 25% 25.7% 412 15.1 57.8 12.6
Bedtime 5% 5.4% 83 3 11.6 2.5
TOTAL 100%

57. Distribution of
exchanges/meal

58. Food Exchanges Total E.M. Breakfast M.M. Lunch Snack Dinner Bedtime
Cereals 5 2 2 1
Pulses 1½ 1½
Nuts 1¼ 1 ¼
Milk & Milk Products 3¼ 1 ½ 1 ¾
Vegetable A ¾ ½ ¼
Vegetable B 1¾ ¾ ½ ½
Fruits 2 1 1
Fats and Oils 24 6g 6g 6g 6g
Sugar 19 5g 2g 3g 5g 4g
Miscellaneous 1 1
TOTAL ENERGY (kcal) 1650 73 408 84 404 166 424 91
Ideal energy (kcal) 1650 83 412 83 412 165 412 83
Total protein (g) 60.3 5.3 14.2 2.7 15.9 3.2 18.2 0.8
Ideal protein (g) 60.3 3 15.1 3 15.1 6 15.1 3
Total cho (g) 231.3 12.5 51.3 15.8 53 22 61.7 15
Ideal cho (g) 231.3 11.6 57.8 11.6 57.8 23.1 57.8 11.6
Total fat (g) 50.2 0.2 16.5 0.1 14.6 7.2 11.4 -
Ideal fat (g) 50.2 2.5 12.6 2.5 12.6 5 12.6 2.5

59. Menu Planning

60. Variations-
Tea
Meal Menu Ing. Ex. Amt (g)
Early
Morning Sweet Milk
Skim
Milk 1 150ml
6.30-7am Sugar 5g
High Biological
Value Protein

61. Meal Menu Ingredients Ex Amt (g)
Breakfast Methi Khakra Wheat flour 1 30g
8.30-9am Fenugreek ¼ 25g
Oats Upma Oats 1 30g
Peanuts 1 15g
Peas ½ 25g
Tomato ½ 50g
Oil 6g
Variations- Thepla,
Broken Wheat Upma
Fibre
Soluble Fiber,
Vitamin C, Anti-
oxidant oil

62. Meal Menu Ing. Ex. Amt (g)
Mid
morning
Muskmelon Milk
Shake
Musk
Melon 1 150g
10.30-
11am Milk ½ 75ml
Sugar 2g
Variations-Banana
Milkshake, Chikku
Milkshake
High Potassium, High
BV Protein

63. Meal Menu Ing. Ex. Amt (g)
Lunch
Paneer Sabzi
with Roti Paneer 1 40g
1-2pm Oil 3g
Wheatfl
our 1 30g
Pea Pulao Rice 1 30g
Peas ½ 25g
Oil 3g
High Biological
value protein,
fiber, Vitamins
and Minerals
Low sodium
Variation: Tadka
Raita with Roti

64. Meal Menu Ing. Ex. Amt (g)
Snack
Spinach Corn
Soup
Tender
Corn 1 100g
5-5.30pm Spinach ¼ 25g
Sugar 3g 3g
Oil 6g
Antioxidant,
Rich source of
phytochemicals
High
Potassium,
fiber
Anti oxidant
oil
Variations- Sweet
Corn Soup, Corn
Tomato Soup

65. Meal Menu Ing. Ex.
Amt
(g)
Dinner
Kadhi
Khichadi Rice 1 30g
8.30-
9pm Lentil 1 30g
Peas ½ 25g
Oil 3g
Soluble
fiber
Low
sodium,
Vitamin C
Variation-
Masoor Pulao

66. Meal Menu Ing. Ex. Amt (g)
Bedtime
Apple
Cinnamon
Wedges Apple 1 90g
10.30-
11pm
Walnut
s ¼ 4g
Sugar 4g
Soluble fiber,
Omega 3
Variations-Stewed
Pineapple/Apple

67. Conclusion

68. Consume Medicines on Time. Monitor your time and
dosage of medicines.
Regulate Sodium Intake. Monitor Sodium through Diet
and Processed Foods
Eat Good Quality Protein. Increase Intake of High
Biological Value Protein from sources like Milk, Paneer,
Curd etc.

69. Thank You