Chronic Renal Insufficiency
Weight at 105 lb. ; 47.5 KG
Protein at .7 grams / KG body weight
= 36 grams protein / day
at 10% - 15% of total calories;
1200 calories / day Intake:
Protein at 12% of total calories = 144 calories / day
(132 -156 calories @10% - 15% protein of total calories)
(36 grams +/- 3 @10% - 15% protein of total calories)
at 43% = 516 calories / day
Sugar at 25% = 300 calories / day
Fat at 20%
= 240 calories / day
diet helps decrease acidosis or acid reflux caused by excessive acidic pH from food intake.
Reflux nephropathy occurs when kidneys are damaged by the backflow of urine into
the kidneys, i.e. urinary tract infections.
disease affects red blood cell production, blood pressure control, Vitamin D, etc.
High blood pressure is almost always present with chronic kidney disease.
Kidney tests include: creatinine levels, BUN, and creatinine clearance.
Albumin (protein) measurement: purchase of a dip-stick test is an estimation of the urine albumin and creatinine content.
The amount of creatinine in urea excreted in the urine can be used to calculate the level of GFR. GFR is
also estimated by blood testing.
Creatinine and urea (BUN) in the blood: Blood urea
nitrogen and serum creatinine tests. Creatinin is a product of normal muscle breakdown. Urea
is the waste product of protein.
In general, kidneys are shrunken in size in Chronic Kidney Disease (CKD).
3 urine formation processes: Glomerular filtration, tubular secretion and tubular
reabsorption. Disease conditions that interfere with these functions are inflammatory and degenerative
diseases that involve the small blood vessels and membranes in the nephrons.
Urinary tract infections and kidney stones interfere with normal drainage, causing further infection
and tissue damage. Circulatory disorders such as hypertension can damage the small renal arteries.
Nephrotic Syndrome: An injury to the glomerular membrane results in loss of albumin
and other kinds of protein in the urine. Loss of albumin leads to edema. Low albumin
levels also trigger cholesterol and lipo-protein synthesis in the liver, resulting in hyperlipidemia. Hepatic
catabolism is serum lipoproteins is reduced and urinary secretion of HDL is increased. These lipid abnormalities
can be exacerbated by medications often used to treat Nephrotic Syndrome.
tests for: potassium, sodium, albumin, phosphorus, calcium, cholesterol, magnesium, CVC, electrolytes.
Renal fibrosis is a common sequence of CKD (Chronic Kidney Disease).
Standard therapy for CKD includes dietary protein restrictions, blood pressure
control as key to delaying further kidney damage most often used ACE (angiotensin-converting enzyme)
and ARBs (angiotensin receptor blockers).
High blood pressure medications should be taken during advanced chronic renal insufficiency.
Rhubarb: More than 20 kinds of anthraquinones have
been identified and have therapeutic effects on a low protein (.6g/kg) and low-phosphorus (10mg/kg) diet. A
progression rate of renal failure was reduced markedly in both rhubarb and rhubarb plus Captopril
group. Rhubarb may prevent progression of CRF (Chronic Renal Failure) by unique and multiple effects on metabolism
of renal tubular and mesangial cells.
plus Angelica, Ligusticum, Triptolive and rhubarb show slowing progressive renal disease and include anti-inflammation
and inhibition of TFG over-production.
a mixture of Astragalus plus Angelica, Ligusticum, Triptolide and Rhubarb have a beneficial role in slowing the progression
of CKD. This effect is multi-functional and multi-targeted, and is often associated with reduction in proteinuria
and the amelioration of dyslipidaemia, but not with changes in systemic blood pressure. These mechanisms
include anti-inflammation and inhibition of TFG-b overproduction. Astragalus had no adverse affects as
high as 100g/kg of raw herb.
of nephritic syndrome: Disorders of lipid metabolism may also enhance the renal injury in CKD.
Most studies have shown the Astragalus alone or combined with other herbs, such as Angelica, Ligusticum (Ligusticum
wallichii) or Schizandrae not only improves oedema, increases serum albumin level and lowers proteinuria, but also reduces
serum total cholesterol, triglyceride & low-density lipoprotein (LDL).
Immunomodulating effects: Astragalus has beneficial immunoregulating effects
with Astragalus stimulating natural killer cell cytotoxicity. Similarly, a higher blood level of interleukin
and tumor necrosis factor and increased T and B lymphocytes and antibody production. The effect of Astragalus
at 40g/day on improving renal function was comparable to Captopril at 75mg/day. Astragalus plays a role
in attenuating the infiltration of inflammatory cells and promoting recovery from renal ischaemia reperfusion injury.
A mixture of Astragalus and Angelica has been shown to protect the kidneys against ischaemic injury and accelerate
TGF (transforming growth factor) is a key regulator
that influences the progression of renal fibrosis. Astragalus and Angelica or Ligusticum slow progression
of CKD. The mechanisms include inhibition of TGF and osteopontin following reduced infiltration of macrophages
and limitation of renal intrinsic cell activation, reduction of proteinuria and correction of Hypoalbuminaemia and Hyperlipidaemia.
Nephropathy therapeutic interventions include: normalization of blood glucose
control, anti-hypertensive treatment, and dietary protein restrictions. In treatment with Astragalus
injections of 32g/day or Captopril at 75g/day, Astragalus group dropped twice as much. Astragalus
and Rhein (Rhubarb) together exert a protective effect on diabetic renal damage.
45-65% of Calories = Carbohydrates, 20-35% = Fat and 10-35% = Protein. Protein intake is 28g/kg of normal
body weight. Low protein diet for CKD is 10-15% of calories in Protein.
Dietary protein at .6g/kg adjusted depending upon GFR plus gram-for-gram replacement of urinary protein losses
is recommended to prevent catabolism. Vegetarian protein is recommended at .7g/kg per day.
Animal proteins cause calcium to be leached from the bones and excreted in the urine, also increasing uric acid excretion.
Foods highest in Purines at 400 muric acid per 100g average. Moderate Purines at 100-400 mg muric
acid per 100g. Low Purines 100 muric acid per 100g.
in excess increases glomerular pressure and hyper-filtration; too much protein stresses the kidneys. Relationship
between dietary protein and rates of urea excretion; increased protein intake elevates rates of creatinine and rates of urea
Diet plans should have an eye toward the possibility
of uremia from metabolic acidosis, fluid and electrolyte imbalances, infection and tissue destruction.
Protein intake in acute renal failure shoud be at .5-.6g/kg until dialysis and then increased to 1.0-1.5g/kg
to compensate for protein losses in dialysate. Calories are generally elevated under stressful conditions
through use of carbohydrates.
Oral supplement of 6 selective amino acids arrest progression of renal failure
in uremic patients. Certain amino acids such as glycine, L-aspartic acid, L-glutamic acid, L-glutamine,
L-histine and L-arginine taken orally by normal adults or patients with renal failure increase glomerular
filtration rate (GFR).
Asparagus contains alkaloids
that may boosts kidney performance and improves waste removal.
Brussels Sprouts stimulate both the kidneys and pancreas.
Carrots are a great source of carotene that speeds the metabolic rate of the body and hastens
removal of fat deposits and wastes.
Should comprise no more than 25% of total calories and is distinguished from natural sugars such as lactose found in
milk and fructose found in fruits.
Quercetin may inhibit Xanthine
oxidase, the3 enzyme required to convert purines into uric acid.
was found to be helpful because it inhibited Xanthine oxidase.
aids uric acid by raising pH of urine (higher body pH levels make uric acid more soluble, thus are better excreted and can
minimize potential kidney stones.
Fish Oils have anti-inflammatory
properties. Verify they are manufacture with a molecular distillation process to eliminate PCBs, etc.
Cherries block inflammation and lower uric acid levels. Supplemental extracts, and juice
and in the dry form can be taken.
Potassium is used to treat high blood pressure,
Alzheimer’s, chronic fatigue syndrome, muscle weakness or dysterophy, and stress.
Prevention: regular exercise, cholesterol control,
Other treatments may include: phosphate binders, treatment for anemia, extra calcium and Vitamin
diet, salt, potassium, phorphorus.
Sodium adds stress. Addition
intake of additional water does not help, but rather makes the condition worse. Excessive sodium and fluid
intake can be life threatening. High sodium foods must be eliminated; especially treated meats, etc.
Low-sodium foods include white cheeses, ...
and noodles are preferable to canned varieties.
packed in water rather than oil without added salt is preferred.
helps to alkalize the body, thus causing more uric acid to be excreted.
With chronic kidney disease, phosphorus levels can become too high. This can cause low
calcium, itching, which may require phosphorus binders and Vitamin D supplement.
Effects of dietary protein restriction at a low-protein diet at .6g/lg the GFR declines for the short term
and slower after that. Patients with the lowest protein intake had the slowest GFR rate of decline.
Not Recommended: Potassium, Magnesium, & Vitamin C due to relationship
between serum concentration of oxalic acid and ascorbic acid.
supplements should be avoided.
High urine volume might cause
faster kidney disease progression due to higher urine volume increases intratubular volume and pressure, and these stretch
forces could induce fibrogenic mechanisms. Increased fluid intake may also lead to intravascular volume
expansion, and eventually to increase in BP, one of the major factors in kidney disease progression.
Lysine supplement high intake (3000mg/day case example). Lysine is reported to cause tubulointerstitial
nephritis and Fanconi Syndrome (impaired renal proximal tubular function) and may lead to acidosis, dehydration and electrolyte
Kidney stones are composed of Calcium, Oxalate,
urate, cysteine, or struvite. Vitamin C metabolized to oxalate before kidney filtration and tubular reabsorption.
Excessive (60g/day) intake of Vitamin C resulted in oxalate in the tubules.
Cranberries contain oxalate. One 450mg tablet contains 180mg oxalate. Concentrated
cranberry tablets increase the risk for Calcium oxalate stone formation.
and other anti-inflammatory drugs cause inhibition of renal prostaglandins, resulting in renal vassal constriction and ischemia
due to long-term exposure.
aqueous solution phosphates exist in four forms ranging from acid to base pH zero to 14 with pH 7 to 9 as HPO4(-2) or pH 14
Phosphates commonly found in ATP DNA and RNA.
Phosphate is useful in animal cells as a buffering agent.
begins to be a consideration once dialysis begins.
glycerophosphate is a phosphorus and calcium dietary supplement which acts as a base when added to food or drink,
bringing the acid down to a neutral level. It is known to reduce cellular
inflammation in the urinary bladder. It is known as an acid-blocker.
Calcium glycerophosphate is a specially processed solution containing calcium glycerophosphate and calcium lactate.
Calcium glycerophosphate is isotonic, with a pH of about 7 or somewhat above. (Other calcium solutions are usually quite acid,
with pH values of 4.5 to 5.5). Each 10 ml Calphosan contains calcium glycerophosphate 50 mg and calcium lactate 50 mg in a
physiological solution of sodium chloride, with 0.25% phenol as a preservative.
Lecithin, a lipid material composed of choline and inositol, is found in all living cells as a
major component of cell membranes, which regulate the nutrients entering and exiting the cell. The term "lecithin"
has two definitions depending on what group is using the term. Scientists define lecithin as synonymous with phosphatidylcholine,
the name for one of the principle phospholipids. On the other hand, producers of lecithin for commercial use use the term
lecithin to refer to a complex mix of phosphatides and other substances that contain phosphatidylcholine. Many
studies have been administered to test lecithin's effect on Alzheimer's disease. Lecithin produces the neurotransmitter
acetylcholine which enables communication and signal-transmission between brain cells. Alzheimer's disease can be caused
by a change in production of acetylcholine.
Lecithin is one of the special chemicals that easily
crosses the blood-brain barrier. "It is believed that lecithin permeability is necessary for the metabolic processes
that occur in all cells but also for the constant regeneration of the phospholipid-rich membranes of the brain." The
choline-containing phospholipid is an abundant form of lecithin and vitally important for the biosynthesis of the important
Most people do not feel any side
effects when taking 10 to 30 grams per day of lecithin supplements. (Zeisel, 332) But in higher doses, lecithin supplements
could cause gastrointestinal problems, diarrhea, weight gain, a rash and headache, nausea, vomiting, dizziness, and/or a "fishy"
RDA: 5mcg (200IU) Vitamin D supplements come in 2 forms: D2
(Ergocalciferol) and D3 (Cholecalciferol). Vitamin D3 is three times more effective than Vitamin D2 in raising
serum 25(OH)D concentrations. Vitamin D deficiency symptoms include: weak muscles & bones. Optimal
serum concentrations are not established. Desirable concentrations of 20 is >30ng/mL. Note
that Vitamin D supplement intakes of 400 IU/day increase 25(OH)D concentrations by only 3-5ng/mL and 1700IU raise concentrations
Vitamin D is converted by the liver
to 25(OH)D aka Calcidiol. The kidneys form 1,25(OH)2D aka Calcitriol. Vitamin
D is essential for promoting Calcium absorption and maintaining serum Calcium and Phosphate concentrations. Vitamin
D has other roles including modulation of neuromuscular, immune function and reduction of inflammation. Many
genes in codeine proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by Vitamin
D. Vitamin D receptors convert 25(OH)D to 1,25(OH)2D.
Serum concentration of 25(OH)D is the best indicator of Vitamin D status. It reflects Vitamin
D produced cutaneously and D supplements, and has a circulating half-life of 15 days. However, serum 25(D)
levels do not indicate the amount of Vitamin D stored in the tissues.
Vitamin D in the form of 1,25(OH)2D is generally not a good indicator of Vitamin D status because of its half-life
of 15 hours and serum concentrations regulated, and do not typically decrease until Vitamin D deficiency is severe.
A concentration of <15ng/mL or <37 net nmoL/L. Concentrations >15/ml (>37nmol/L) are
Vitamin D toxicity associated
with supplements of Calcium at 1000mg/day and Vitamin D at 400IU/day equal 17% increased risk of kidney stones.
Deposits of Calcium and phosphate in the kidneys can also be caused by excessive Vitamin D. A serum
25(OH)D concentration consistently >200ng/mL is toxic.
Corticosteroid medications can reduce Calcium and absorption and impair Vitamin D metabolism.
Renal Insufficiency Signs & Symptoms: nausea, vomiting, constant fatigue,
nails turning white towards the ends, itchy skin, magnesium toxicity, elevated homocysteine levels, high-triglycerides,
headaches, hyperuricemia (gout) (impaired renal function filter and an excretion of less uric acid associated with high plasma
urate levels), boils, abcesses & carbuncles.
that suggest Chronic Renal Insufficiency: kidneys no longer produce sufficient erythrocytin, a hormone
that stimulates RBCs and accumulate toxic metabolites that shorten the lifespan of existing RBCs.
Recommendations for Chronic Renal Insufficiency: CHITOSAN is highly
recommended. Baking soda is also shown to slow the decline of kidney function in CKD.
Rate of decline decreased 2/3 more slowly (highly recommended).
Serum Creatinine exceeding 2.0 mg/dL or 175 Umole/L is generally considered
the point of no return from Chronic Renal Insufficiency.
Blood pressure control
is of particular importance with CKD. Physical inactivity is associated with
CKD. There’s an inverse relationship between dietary protein intake and
systemic blood pressure. Increased protein intake often results in increased nutrients related to impacting
blood pressure, e.g. Potassium, Magnesium & Calcium.
Phosphorus and Calcium:
levels and acid-based balance: Kidney disfunction causes imbalances in Potassium (especially), Phosphorus
and Calcium. The acid base balance of the blood is usually also disrupted.
Calcium supplements can be taken with meals as a phosphorus binder during advanced chronic
Phosphorus begins to be a consideration once
dialysis begins and phosphate binder medications are initiated.
and CKD: Kidney disease patients at stages 3 & 4 should keep their Phosphorus levels between 2.7 and
4.6 mg per dL. Dialysis patients at 3.5 to 5.5 ng/dL and Calcium between 8.4 and 10.2, preferably 9.5 ng/dL.
Doctors may prescribe an active form of Vitamin
D called Calcitriol which balances the Calcium and Phosphorus levels. Active Vitamin D
cannot be taken if Calcium or Phosphorus levels are too high.
Potassium is the principal cation in the intra-cellular fluid. It maintains
cell integrity, regulates neuro-muscular stimulation, maintains
normal osmotic pressures both within and out of the cells, and protein metabolism. Normal potassium intake
recommended at 3-4g/day.
Potassium restrictions depend on serum
Vitamin supplements of B12, folate and thiamin are
also suggested, but no mineral supplements; phosphorus is unrestricted. Adequate intakes at 700 mg/day.
Functions include serum buffer, energy transfers and fatty acid transfer.
Chronic Renal Failure
Failure: 90% of cases of end-stage renal disease are attributable to diabetes mellitus, glomerulonephritis or
hypertension. Kidney failure results in fluid and electrolyte imbalances, the buildup of nitrogenous
waste and reduced ability to produce renal hormones. Options: transplant or dialysis.
Dialysis: Dietary changes include restrictions in protein, sodium, potassium, phosphorus
and fluid. Patients on continuous ambulatory peritoneal dialysis can be more liberal in protein/sodium/potassium/fluid
Kidney Failure causes high levels of phosphorus to build up in
the blood and disrupts calcium / phosphorus balance. Recommended intakes usually range from 800-100 mg/day
with hemodialysis and <1200mg/day with peritoneal dialysis.
Kidneys may not be able to remove all phosphorus, which results in phosphorus buildup in the blood; consequently
blood calcium levels drop and calcium is leached from the bones. A phosphorus binder medication may be
Kidneys remove toxins and unless they are working
properly, begin to retain fluid. This fluid is held by the cells, which results in the face appearing puffy,
especially after a salty meal, requiring increased water intake to flush out the sodium. However, an overload
of salt additional water does not help, but in fact makes the situation worse. Sodium restrictions are
paramount. Low-salt varieties of foods are acceptable, e.g. tuna packed in water. Ingest
maximum 8 cups (64 oz.) of water per day.
Vitamin Toxicity in CKD/ESRD Patients: Recommendations for kidney failure patients and Vitamin A supplementation? "[in ESRD patients] levels
are usually elevated; supplementation not recommended, may cause toxic levels". The bottom
line: ESRD patients should avoid vitamin A supplements. Since this vitamin is fat-soluble, not water-soluble, it
can build up to higher than normal levels in people on dialysis.
Carotenemia is a benign condition most commonly occurring
in vegetarians. high doses of beta carotene have been found to be harmless.