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1. NUTRITION AND
RENAL DISEASES
PREPARED BY; MR. HABIIB ABD-WAHAB NASSER
FOR 2ND AND 3RD YEAR STUDENTS OF NUTRITION & FOOD
SCIENCE – EAU(GAROWE)

2. KIDNEYS
 Kidneys is involved in the urinary system.
 They are responsible for filtering the blood and removing excess fluid and wastes
for elimination in urine.
 The functional unit of the kidneys are the nephrons, which consists the
glomerulus and tubules.
 The glomerulus, a ball-shaped tuft of capillaries, serves as a gateway through
which blood components must pass to form filtrate.
 The glomerulus and surrounding Bowman’s capsule function like a sieve,
retaining blood cells and most plasma proteins in the blood while allowing fluid
and small solutes to enter the nephron’s system of tubules.
 As the filtrate moves through the tubules, its composition continuously changes
as some of its components are reabsorbed and returned to the blood via
capillaries surrounding the tubules;
 the remaining substances contribute to the final urine product.

4. Functions of the kidneys
 Filtering the blood to remove excess waste to form
urine,
 The kidneys regulate the extracellular fluid volume
and osmolarity(concentration of solutions expressed
as total number of solute per liter), electrolyte (ions)
concentrations, and acid–base balance.
 They also excrete metabolic waste products such as
urea and various drugs and toxicants.

5. Other roles of the kidneys include
the following:
 Secretion of the enzyme renin, which helps to regulate
blood pressure.
 Production of the hormone erythropoietin, which
stimulates the production of red blood cells in the
bone marrow.
 Conversion of vitamin D to its active form, thereby
helping to regulate calcium balance and bone
formation.

6. NEPHROTIC SYNDROME
 Nephrotic syndrome refers to a condition caused by significant
urinary protein losses (proteinuria) that result from severe
glomerular damage.
 The condition arises because damage to the glomeruli
increases their permeability to plasma proteins, allowing the
proteins to escape into the urine.
 The loss of these proteins may cause serious consequences,
including edema, blood lipid abnormalities, blood coagulation
disorders, and infections.
 In some cases, the nephrotic syndrome can progress to kidney
failure.

7. CAUSES OF NEPHROTIC SYNDROME.
Causes of the nephrotic syndrome include;
 Glomerular disorders,
 Diabetic nephropathy (Kidney disease as a result oof
increased blood sugar levels),
 Immunological and hereditary diseases,
 Infections (involving the kidneys or elsewhere in the body),
 Chemical damage (from medications or illicit drugs),
 Some cancers. Depending on the underlying condition.

8. CONSEQUENCES OF THE NEPHROTIC
SYNDROME
 Although protein losses vary, proteinuria in adult patients may average
as much as 10 grams daily.
 The liver tries to compensate by increasing its synthesis of various
plasma proteins, but some of the proteins are produced in excessive
amounts.
 The imbalance in plasma protein concentrations contributes to a
number of complications which include the following;
 Edema (swelling caused by excess fluids in the body tissues)
 Blood Lipid and Blood Clotting Abnormalities:
 Loss of immunoglobulins (antibodies) and vitamin D–binding protein

9. Edema:
 Albumin (protein soluble in water) is the most abundant plasma
protein, and it is the protein with the most significant urinary
losses as well.
 The hypoalbuminemia characteristic of the nephrotic syndrome
contributes to a fluid shift from blood plasma to the interstitial
spaces and, thus, edema.
 Impaired sodium excretion also contributes to edema: the
nephrotic kidney tends to reabsorb sodium in greater amounts
than usual, causing sodium and water retention within the
body.

10. Blood Lipid and Blood Clotting
Abnormalities:
 Individuals with the nephrotic syndrome frequently
have elevated levels of low-density lipoproteins (LDL) –
bad cholesterol
 Furthermore, blood clotting risk is increased due to
urinary losses of proteins that inhibit blood clotting.
 The nephrotic syndrome is associated with increased
risk of heart disease and stroke.

11. Other Effects of the Nephrotic
Syndrome:
 The proteins lost in urine include immunoglobulins (antibodies)
and vitamin D–binding protein.
 Depletion of immunoglobulins increases susceptibility to
infection.
 Loss of vitamin D–binding protein results in lower vitamin D and
calcium levels and increases the risk of rickets in children.
 If proteinuria continues, protein-energy malnutrition (PEM) and
muscle wasting may develop.

12. TREATMENT OF THE NEPHROTIC
SYNDROME
 Medical treatment of the nephrotic syndrome requires diagnosis
and management of the underlying disorder responsible for the
proteinuria.
 Complications are managed with medications and nutrition
therapy.
 The drugs prescribed may include diuretics, angiotensin-
converting enzyme (ACE) inhibitors and angiotensin-receptor
blockers (which reduce protein losses).
 Nutrition therapy can help to prevent PEM, alleviate edema,
and correct lipid abnormalities.

13. NUTRITION RECOMMENDATION TO
MANAGE NEPHROTIC SYNDROME
Protein and Energy:
 Meeting protein and energy needs helps to minimize losses of muscle
tissue.
 High-protein diets are not advised, however, because they can
exacerbate or worsen urinary protein losses and result in further
damage to the kidneys.
 The protein intake should fall between 0.8 and 1.0 gram per kilogram of
body weight per day.
 An adequate energy intake (about 35 kcalories per kilogram of body
weight daily) sustains weight and spares protein. Weight loss or
infections suggest the need for additional energy.

14. Lipids:
 A diet low in saturated fat, trans fats (unhealthy fat that’s solid
at room temperature), and refined sugars may help to control
elevated low density lipoprotein LDL (bad cholesterol) levels.
 Stay away from foods like, butter, palm and coconut oils,
cheese and red meat.
 Dietary measures are usually inadequate for controlling blood
lipids, however, so physicians may prescribe lipid lowering
medications as well.

15. Sodium and Potassium:
 Controlling sodium intake helps to control
edema; therefore, the sodium intake may be
limited to 1000 to 2000 milligrams daily.
 If diuretics prescribed for the edema cause
potassium losses, patients are encouraged to
select foods rich in potassium.
NB: Diuretics are medicines that increase urine formation.

16. Vitamins and Minerals:
 Multivitamin/mineral supplementation can help
patients avoid nutrient deficiencies.
 Nutrients at risk include iron and vitamin D.
 To reduce risk of bone loss, calcium
supplementation (about 1000 to 1500 milligrams
per day) may also be advised.