Therapeutic Nutrition For Diseases Of The Kidneys And Urinary Tract

Dean Rouseberg Author: Dean Rouseberg Time for reading: ~26 minutes Last Updated: September 12, 2022
Therapeutic nutrition for diseases of the kidneys and urinary tract

An important role of therapeutic nutrition in the complex therapy of kidney diseases is determined by pronounced metabolic disorders, possible violations of the digestive organs.

An important role of therapeutic nutrition in the complex therapy of kidney diseases is determined by pronounced metabolic disorders, possible violations of the digestive organs.

Diet therapy is built taking into account the main pathogenetic mechanisms of the disease and provides for the need to spare the kidneys, leveling metabolic disorders, and potentiating the action of diuretics and other medications. The possibility of concomitant circulatory failure determines the need to spare the organs of the cardiovascular system.

The main differences during dietary therapy relate to the amounts of protein, salt and water, which is determined by the clinical form, the period of the disease and the functional ability of the kidneys. The presence or absence of edema, high blood pressure, azotemia, albuminuria, hypoproteinemia and their severity matters. So, the presence of azotemia determines the need for protein restriction, with edema and high blood pressure, salt is limited. Noteworthy is the fact that there is no fluid retention in the body against the background of a salt-free diet, and therefore the allowable volume of fluid consumed is determined by diuresis plus 500 ml (extrarenal losses).

Since edema may be associated with proteinuria, the presence of ionoproteinemia in the absence of azotemia dictates the need for protein enrichment in the diet.

It should be borne in mind the need to enrich the diet with potassium when prescribing a number of diuretics that contribute to its excretion in the urine and can lead to hypokalemia (dichlothiazide, furosemide, etc.).

Therapeutic nutrition for kidney diseases involves the use of kidney diets No. 7a, 76, 7, such as Giordano-Giovanetti and special unloading diets (sugar, apple, potato, rice-compote, watermelon, pumpkin, etc.), which contribute to the removal of fluid and underoxidized products exchange from the body, lowering blood pressure and reducing azotemia.

Among the main pathological conditions of the kidneys, in which dietary therapy deserves special attention, are acute and chronic renal failure, nephrotic syndrome, acute chronic glomerulonephritis, acute and chronic pyelonephritis, kidney amyloidosis (however, with amyloidosis of the kidneys, therapeutic nutrition is similar to that in nephrotic syndrome).

Diet for acute and chronic renal failure

Acute renal failure is characterized by a sudden and rapidly progressive impairment of all functions of the nephron with the development of azotemia, profound disturbances in water and electrolyte metabolism, acid-base balance, arterial hypertension and anemia of the patient.

Depending on the mechanism of action, the etiological factors of acute renal failure are usually divided into prerenal (acute blood loss, traumatic and operational shock, transfusion of incompatible blood, crushing of tissues, toxic infections, indomitable vomiting, mowing, etc.), renal (poisoning with metal salts, organic compounds, poisons of plant and animal origin, drugs, etc.) and postrenal (compression and blockage of the urinary tract in urolithiasis, prostate adenoma, tumors of the pelvic organs).

Therapeutic nutrition in acute renal failure is aimed at preventing the breakdown of tissue proteins, sparing the kidneys to the maximum and correcting metabolic disorders. It is built differentially in accordance with the stage of the disease.

In the initial (shock) period, diet therapy is in many cases impossible (unconsciousness due to shock, trauma, condition after abdominal surgery, etc.); therefore, in this period, treatment is usually reduced to parenteral administration.

In the stage of oliguria, fluid intake should be limited to 400-500 ml per day, plus the amount of fluid lost during vomiting and diarrhea. It is also necessary to sharply limit the introduction of potassium, since its concentration in the blood plasma increases, which is associated with tissue destruction and impaired excretion of potassium by the kidneys. The content of sodium in the body, despite possible losses during vomiting and diarrhea, usually increases as a result of a violation of its excretion by the kidneys; in this regard, the content of sodium in the diet is also subject to drastic restriction.

Increased protein breakdown and impaired excretion of nitrogenous waste products by the kidneys contribute to a sharp increase in their content in the body, which dictates the need for a strict restriction of protein in the daily diet (up to 20-25 g), provided that it has sufficient calories (at least 1500 kcal). A lower caloric content of the daily diet can increase the breakdown of own (tissue) proteins, which in turn leads to an increase in hyperkalemia. It is advisable to provide the missing calorie content mainly due to easily digestible carbohydrates, which help to improve the functional state of the myocardium, liver, and kidneys. In this regard, levulose is especially indicated, which, under conditions of acidosis, can be transformed by the damaged liver into glycogen. The introduction of fats should be limited, because in the process of impaired metabolism, ketone bodies accumulate,

With the onset of the polyuric stage, protein restriction in the diet should be continued until residual nitrogen in the blood returns to normal. Increased diuresis determines the need to drink plenty of fluids. With the onset of diuresis over 1500 ml, the potassium content in the diet can not be limited; moreover, with a further increase in urine volume, it is necessary to enrich the diet with potassium, since its content in the blood tends to decrease. The introduction of sodium should be carried out under the control of its content in the blood and excretion in the urine.

Chronic renal failure (uremia) can develop with chronic diffuse glomerulonephritis, bilateral pyelonephritis, polycystic and amyloidosis of the kidneys, hypertension and atherosclerotic kidney damage (nephroangiosclerosis), diabetic glomerulosclerosis, kidney damage with systemic lupus erythematosus, periarteritis nodosa, chronic circulatory failure and less than other diseases.

In connection with the violation of the filtration capacity of the kidneys, nitrogenous wastes are retained in the body and the specific gravity of urine decreases. As a result of the compensatory reaction of the body, reabsorption in the tubules changes, contributing to the excretion of accumulated nitrogenous wastes with a large volume of low-concentrated urine; moreover, the observed polyuria often contributes to the convergence of edema. Large amounts of sodium and potassium are lost in the urine; acidosis develops. In the future, when the filtration capacity of the kidneys falls even more, oliguria develops, which leads to a further increase in residual blood nitrogen.

Diet therapy for chronic renal failure is aimed at reducing the effects of azotemia, combating acidosis and other metabolic disorders with maximum sparing of the kidneys.

The amount of protein in the diet is subject to restriction depending on the degree of renal insufficiency. According to most nephrologists (E.M. Tareev, M.Ya-Ratner, M.S. Vovsi), the amount of protein should be reduced to 0.4-0.6 g per 1 kg of body weight per day, which approximately corresponds to the nitrogenous minimum of the body. It is recommended to use mainly plant proteins, the metabolic products of which are more easily excreted from the body. In addition, plant products rich in alkaline valences contribute to alkalization of the body, which has a positive effect, since acidosis develops in chronic renal failure.

To ensure sufficient caloric content of the daily diet, it is necessary to increase the content of carbohydrates and fats in it.

Salt should not be severely limited. In the absence of edema, the introduction of 4-5 g of salt is allowed. Moreover, with compensatory polyuria, when a lot of sodium is lost in the urine, the amount of salt in the diet must be increased (up to 5-6 g per 1000 ml of fluid)1 otherwise dehydration may occur with a further decrease in glomerular filtration. When metabolic acidosis occurs, it is recommended to replace 1/5 of the injected sodium chloride (salt) with sodium bicarbonate (soda) - 2-3 g.

Fluid intake is not limited, and with compensatory polyuria it even increases to a volume corresponding to daily urine output plus 500 ml (extrarenal losses). The introduction of a sufficient amount of fluid is necessary to flush out nitrogenous toxins from the body.

The development of anemia dictates the need to consume foods rich in cyanocobalamin, folic acid, iron (lettuce, potatoes, apples, tomatoes, oatmeal and pearl barley, etc.).

With mild renal failure (urea clearance 30-40 ml / min), the diet approaches the treatment table No. 76 with the issuance of 4-5 g of salt on the hands and the introduction of a sufficient amount of liquid. Periodic (once a week) fasting days are shown by prescribing diet No. 7a or taking into account the individual tastes and wishes of the patient, special fasting rations (sugar, pumpkin, rice compote, watermelon, potato, apple, etc.). Due to the low calorie content, fasting days are necessary in the conditions of patient compliance with bed rest; fasting days contribute to the removal of nitrogenous toxins from the body.

In the period of severe renal insufficiency (urea clearance 10-15 ml / min), the Ka 7a diet is more appropriate with the issuance of salt on the hands (up to 8-12 g per day) and the introduction of a sufficient amount of liquid. With a decrease in the phenomena of renal failure, patients should be gradually transferred to diet No. 76 with the periodic inclusion of fasting days in the form of diet No. 7a or special fasting rations (watermelon, pumpkin, sugar, rice compote, etc.).

Noteworthy is the use of a special diet such as Giordano-Giovanetti. It was found that the human body, under the conditions of ensuring energy consumption from carbohydrates and fats (to avoid spending its own proteins for energy purposes) and introducing essential amino acids with food, is able to synthesize the remaining (non-essential) amino acids by resynthesis of nitrogen from endogenously formed urea. This led scientists to think about the possibility of using endogenous urea for protein synthesis in the body, which is formed as a result of the introduction of proteins containing essential amino acids with food. Based on this, Giovanetti and Magiore (1964) proposed for long-term use in chronic renal failure a fairly high-calorie (2200-2500 kcal) low-protein diet, but with a sufficient amount of complete proteins (18-25 g), provide the body with essential amino acids. The calorie content of the diet is achieved mainly due to carbohydrates (230-380 g) and fats (120-130 g). Salt is introduced in the amount of 2-5 g; instead of salt, its substitutes in the form of a mixture of potassium chloride, ammonium, choline and calcium phosphate can be used. Fluid intake is not restricted and corresponds approximately to diuresis; it should be limited only with severe edema and heart failure. The main source of protein in the diet is egg white. Bread, meat and fish are excluded, as they contain a large amount of acid radicals that aggravate acidosis. Vegetables, fruits, sugar, jam, marmalade, honey, vegetable oils and, to a lesser extent, animal fats are used; it is recommended to include in the diet fruits and vegetables with the lowest nitrogen content (pumpkin, tomatoes, carrots, lettuce, peppers, apples, pears, plums, oranges), flour products (bread, crackers, pasta, etc.). To improve the taste, salt-free dishes are flavored with spices (dill, bay leaf, cinnamon, cloves, allspice, cumin, parsley, vanillin); at the same time, seasonings that irritate the kidneys (horseradish, garlic, radish, mustard) are prohibited.

The diet of the Giordano-Giovanetti type proved to be effective with a urea clearance of at least 2.5–3 ml/min. There have been observations of the beneficial effects of the Giordano-Giovanetti type of diet over several years.

Here is an exemplary diet menu like Giordano-Giovanetti modified by A.F. Dolgodvorova and V.N. Petrova: I 1 breakfast: boiled potatoes - 200 g, egg - 1 pc., tea with sugar, jam (honey) - 50 g.

2 breakfast: sour cream - 100 g, tea with sugar.

Lunch: A. Rice soup - 300 g: butter - 5 g, sour cream - 20 g, potatoes - 100 g, carrots - 20 g, rice - 30 g, onion - 5 g, tomato juice - 5 g.

B. Vegetable stew - 200 g: butter - 10 g, carrots - 70 g, beets - 100 g, rutabaga - 100 g. C. Kissel from fresh apples - 200 g.

Dinner: A. Rice porridge - 200 g rice - 50 g, sugar - 5 g, milk - 100 g, butter - 5 g. B. Tea with sugar. B. Jam (honey) - 50 g.

Every morning the patient receives a "dry ration": 70 g of butter, 100 g of sugar, 1 g of tea and 1 egg.

PREMIUM CHAPTERS ▼

Diet treatment for nephrotic syndrome (PREMIUM)

Nephrotic syndrome is a symptom complex characterized by massive proteinuria, hypo- and dysproteinemia, edema, and hyperlipidemia. Adults usually have a secondary nephrotic syndrome, which can be caused by diffuse glomerulonephritis (acute, subacute, chronic), amyloidosis, diabetic glomerulosclerosis, systemic lupus erythematosus, thrombosis of the renal or inferior vena cava, and less often other diseases. The nephrotic syndrome is based on primary pathological changes in the capillaries of the renal glomeruli, leading to an increase in their permeability to blood serum protein; the tubular apparatus is affected a second time due to reabsorption of protein and cholesterol esters. Increased reabsorption of sodium and water ions.

Therapeutic nutrition in nephrotic syndrome is aimed at combating hypoproteinemia, edema and other metabolic disorders with maximum sparing of the kidneys.

Hypoproteinemia and its role in the genesis of edema dictates the need for sufficient glomerular filtration to introduce an increased amount of protein (1.3-1.5 g per 1 kg of body weight per day). An increase in the protein content in the blood plasma contributes to an increase in its oncotic pressure and a decrease in edema. It is especially advisable to introduce high-grade and easily digestible proteins (meat, fish, cottage cheese, egg white). With a decrease in glomerular filtration rate with the subsequent development of azotemia, the amount of protein in the diet should be limited.

Since sodium is retained in the tissues and plays an important role in the genesis of edema, the amount of salt in the diet is sharply limited; food is prepared without salt, special salt-free bread is used, foods rich in salt (herring, pickles, marinades, etc.) are excluded. However, prolonged use of a salt-free diet can lead to the development of chloropenic azotemia, impaired renal function, hyperaldosteronism, and the appearance of edema that cannot be treated with diuretics. In order to prevent these phenomena, it is recommended to give patients 3-4 g of salt once a week against the background of a salt-free diet. In the stage of polyuria, with a decrease in edema, an increase in the amount of salt is allowed up to the norm, since sodium is lost in large quantities in the urine.

The content of potassium in the diet should be sufficient, as the body loses a lot of it. Potassium promotes the displacement of sodium, and with it fluids from the body and the reduction of edema. It is especially important to enrich the diet with potassium salts when using diuretic drugs that promote the excretion of potassium from the body (dichlorthiazide, furosemide, etc.). However, when diuresis falls below 500 ml, the introduction of potassium should be more careful, since it accumulates in the body and can have a toxic effect; during this period it is desirable to control the content of potassium in the blood. Vegetables and fruits are especially rich in potassium salts.

Against the background of a salt-free diet, the amount of liquid consumed by the patient is not significantly limited. Its quantity should correspond to diuresis plus 500 ml (extrarenal losses).

In the presence of hyperlipidemia, it is advisable to somewhat limit the amount of fat, mainly due to animal fats rich in cholesterol, with their partial replacement with vegetable oils. It is necessary to enrich the diet with lipotropic substances.

Thus, in terms of increased protein content, therapeutic nutrition approaches the therapeutic diet No. 7c. Once every 7-10 days, it is advisable to carry out fasting days (potato, apple, sugar, rice compote, etc.); for this purpose, patients can also be transferred to diet No. 7a or 76. Fasting days contribute to the removal of nitrogenous toxins and fluids from the body.

To improve the taste and tolerance of salt-free food, it is advisable to flavor it with allspice, caraway seeds, bay leaves, acidic fruit juices, and a weak solution of vinegar. Horseradish, radish, mustard, garlic, radish, onion, parsley, dill should not be consumed, as they contain a significant amount of essential oils that irritate the kidneys and increase albuminuria and hematuria; for the same reason, products containing calcium oxalate (spinach, sorrel, etc.) are to be excluded from the diet.

With a pronounced violation of the nitrogen-excreting function of the kidneys, patients are transferred to a diet recommended for chronic renal failure.

Acute, chronic glomerulonephritis and diet therapy (PREMIUM)

Acute glomerulonephritis is an inflammatory disease of the kidneys of an infectious-allergic nature with an initial and predominant lesion of the glomeruli of the nephron.

Therapeutic nutrition in this disease is aimed at providing anti-inflammatory and desensitizing effects, kidney sparing, elimination of water-salt metabolism disorders, arterial hypertension and circulatory failure.

It is advisable to limit the caloric content of the daily diet due to the need to comply with bed rest. Reducing the caloric content of the diet has a beneficial effect on the body also because it reduces the burden on the kidneys and facilitates the activity of the cardiovascular system, which is closely related to the activity of the digestive organs, which is very important in the presence of arterial hypertension and edema. The calorie content of the diet is reduced due to proteins, fats and, to a lesser extent, carbohydrates. The rationale for limiting protein in the diet are indications of its ability to enhance hyperergic reactions. Reducing the amount of protein in the diet also prevents the accumulation of nitrogenous waste in the body. However, in the absence of azotemia, prolonged protein restriction is not justified, primarily because it enhances regeneration processes. It is also necessary to take into account the fact that the end products of protein breakdown (urea) have a diuretic effect. All this determines the expediency after a short-term restriction in the absence of azotemia sufficient introduction of protein into the diet.

The restriction of carbohydrates in the diet may be associated with a possible sensitizing effect, which is especially important when taking into account the genesis of the disease. However, most nephrologists (M.S. Vovsi, G.F. Blagman, S.D. Reizelman, etc.) consider it unreasonable to limit carbohydrates in the diet due to the lack of convincing data, especially since they help to increase the functional capacity of the myocardium, liver , kidneys and other internal organs.

Subject to limiting the amount of fluid and salt, which helps to reduce swelling and lower blood pressure. Sodium restriction also promotes calcium fixation in tissues, which has an anti-inflammatory and desensitizing effect; therefore, calcium-rich foods (milk, cottage cheese, etc.) should be included in the diet. An excess of sodium ions increases the hydrophilicity of tissues and increases osmotic pressure, contributing to water retention in the body; there are indications of the direct pressor effect of sodium on the vessels.

It is recommended to introduce a sufficient amount of potassium, which has a direct depressant effect on the vessels and promotes the displacement of sodium, and with it water from the body, and also has a positive effect on the contractile function of the myocardium, and therefore is especially indicated for concomitant circulatory failure. It is necessary to enrich the diet with potassium ions and in connection with the use of a number of diuretic drugs that contribute to its excretion from the body with urine (dichlorthiazide, furosemide, brinaldix, etc.). An important role in enriching the body with potassium belongs to plant products (vegetables, fruits, berries).

It is necessary that the food contains a sufficient amount of vitamins (ascorbic acid, retinol, vitamin K, thiamine, riboflavin, vitamin P, nicotinic acid). In particular, ascorbic acid and vitamin P thicken the vascular wall and reduce its permeability, retinol promotes the regeneration of the renal epithelium, nicotinic acid dilates blood vessels, exerting a depressant effect, and improves blood supply to the kidneys.

During the first two days, a "hunger and thirst" regimen should be prescribed, when the patient does not receive food and drink. This allows you to create maximum functional unloading for the kidneys and the cardiovascular system, which helps to reduce blood pressure, reduce swelling and circulatory failure. Then, within 1-3 days, it is advisable to carry out unloading days (potato, watermelon, cucumber, pumpkin, grape, sugar) with the restriction of free fluid to 550-450 ml. In the future, for 5-8 days, the patient should be given diet No. 7a, followed by a transition to diets No. 76 (6-7 days) and No. 7. Thus, there is a gradual increase in the daily calorie content, the amount of proteins, fats and carbohydrates (Table 1).

 

Table 1 The composition of the daily diet of "renal" diets

Diet

Calorie content, to cal

Protein, g

Fats, g

Carbohydrates, g

Free liquid, ml

Salt

No. 7a No. 7b No. 7

2000 2500 2800-3000

25-35

50-60 70-80

60 70-80 90-100

350

350-400 400-450

400-450 000 800

4-5 g is excluded (on hand)

 

Diets No. 7 and 76 are almost salt-free, as the food is cooked without salt added; in a small amount (0.5-1 g) salt is found in food products. Only in diet number 7 is given to the hands of 4-g of salt for salting individual dishes. Therefore, to improve the taste, it is recommended to give low-salted and unsalted food a sour (fruit juices) or sweet taste (honey, sugar, jam), flavor it with various spices (bay leaf, a weak solution of vinegar, vanillin, cumin, cinnamon, etc.). It is not allowed: to use seasonings containing essential oils (horseradish, radish, onion, garlic, mustard), as they irritate the kidneys and can increase albuminuria and hematuria; products rich in salt (herring, canned food, marinades, pickles, etc.) are subject to exclusion.

Diet number 7 is assigned to the patient until the disappearance of hematuria and albuminuria. After suffering acute glomerulonephritis, it is necessary for a long time to avoid eating foods rich in salt, marinades, alcoholic beverages, smoked meats, mustard, garlic, sorrel, spinach, horseradish, radish, dill, parsley.

Chronic glomerulonephritis usually develops as a consequence of acute glomerulonephritis, which affects mainly the glomeruli with gradual thickening and death of nephrons. Ultimately, this leads to shrinkage of the kidneys and a decrease in their function with the development of uremia.

Therapeutic nutrition in chronic glomerulonephritis is aimed at reducing the inflammatory-allergic process, maximum sparing of the kidneys, leveling metabolic disorders, and preventing possible disorders of the cardiovascular system. (reducing high blood pressure, eliminating the effects of circulatory failure) and potentiation of the action of certain medications (diuretic, antihypertensive, etc.). It is built taking into account the clinical form, the period of the disease (exacerbation or remission) and the state of the nitrogen excretion function of the kidneys.

Regardless of the form and stage of chronic glomerulonephritis, as well as the state of the nitrogen excretion function of the kidneys, it is necessary to provide the body with a sufficient amount of vitamins (ascorbic acid, vitamin P, nicotinic acid, vitamin K, retinol) (see "Acute glomerulonephritis"). For sufficient provision of the body with vitamins, the use of fruits, vegetables and their juices is indicated.

It is advisable to enrich the diet with calcium salts. They have an anti-inflammatory and desensitizing effect, thicken the vascular wall and reduce the hydrophilicity of tissues. The amount of protein, salt, liquid, carbohydrates and fat in the diet varies depending on the form, phase of the disease and the state of the excretory function of the kidneys.

In the hypertensive form of chronic glomerulonephritis with preservation of kidney function, diet No. 7 is recommended with a sufficient intake of proteins (up to 1 g per 1 kg of body weight per day), fats and carbohydrates. Food is prepared without the addition of salt, but 3-5 g of salt is given to the patient's hands daily to add salt to individual dishes. Sodium promotes fluid retention in the body and has a direct pressor effect. A salt-free diet leads to an increase in diuresis and a decrease in blood plasma volume, which helps to lower blood pressure. Sharp restriction of salt is especially important at the accompanying insufficiency of blood circulation. Salt-rich foods (herring, pickles, marinades, sea fish, canned food, etc.) are excluded. The diet should also be enriched with potassium salts, which are especially rich in vegetables and fruits. Potassium promotes the displacement of sodium and, together with it, fluid from the body (increases natriuresis and diuresis), has a direct depressant effect on the wall of blood vessels. Enrichment of the diet with potassium is especially advisable when using a number of diuretic drugs that contribute to the depletion of the body in potassium due to an increase in its loss in the urine (dichlotizzide, ethacrynic acid, brinaldix, etc.). The need to enrich the diet with potassium is also determined by the fact that against the background of a hyposodium diet, it is more quickly excreted from the body. ethacrynic acid, brinaldix, etc.). The need to enrich the diet with potassium is also determined by the fact that against the background of a hyposodium diet, it is more quickly excreted from the body. ethacrynic acid, brinaldix, etc.). The need to enrich the diet with potassium is also determined by the fact that against the background of a hyposodium diet, it is more quickly excreted from the body.

The amount of fluid consumed should correspond to diuresis plus 500 ml (extrarenal losses).

Sometimes (1-2 times a week) it is advisable to carry out fasting days by prescribing diet No. 76 or apple, compote, sugar, potato, pumpkin, cucumber, watermelon days.

To improve the taste of salt-free dishes, it is advisable to give a sour (sour fruit juices) or sweet taste (jam, honey, sugar), add permitted spices (dill, bay leaf, cumin, a weak solution of vinegar, vanillin, boiled and fried onions). Forbidden: foods that irritate the kidneys (onions, radishes, horseradish, garlic, mustard, sorrel, spinach, smoked meats).

In edematous-albuminuric form of chronic glomerulonephritis, therapeutic nutrition corresponds to that in nephrotic syndrome.

With exacerbation of chronic glomerulonephritis, diet therapy is the same as for acute glomerulonephritis (see "Acute glomerulonephritis").

With the development of violations of the nitrogen-excreting function of the kidneys, therapeutic nutrition is built in the same way as in chronic renal failure (see "Chronic renal failure").

In the compensation stage (in the absence of edema, increased blood pressure, albuminuria), no restrictions are required, the diet should be quite complete and varied.

The diet should be fractional - at least 4-5 times a day.

Pyelonephritis and urolithiasis (PREMIUM)

Pyelonephritis is a nonspecific inflammatory process of a bacterial nature in the renal pelvis, calyces and parenchyma | with a primary lesion of its interstitial tissue. Unlike glomerulonephritis, one kidney can be involved in the process and mainly its tubular apparatus is damaged.

In uncomplicated acute pyelonephritis, there is usually no danger of delay in the body of nitrogenous waste, sodium and fluid. Therefore, dietary restrictions, with the exception of substances that irritate the kidneys and urinary tract (mustard, horseradish, radish, radish, spinach, sorrel, garlic), are not required.

In uncomplicated chronic pyelonephritis, a normal rational diet is recommended. The presence of polyuria determines the need to drink an increased amount of fluid. Salt should not be limited, because due to impaired reabsorption in the tubules of the kidneys, excess sodium is lost in the urine.

When chronic pyelonephritis is complicated by chronic renal failure, therapeutic nutrition is carried out in the same way as in chronic renal failure.

The formation of calculi in the urinary tract occurs as a result of a violation of the colloidal state of urine with atypical crystallization and precipitation of various salts from it. Important in the pathogenesis of the disease belongs to stagnation of urine, the presence of infection in the urinary tract and especially urinary diathesis in combination with a shift in the acid-base balance of urine (acid urine favors the loss of urates and oxalates, and alkaline - phosphates and carbonates).

Therapeutic nutrition for urolithiasis is aimed at preventing the formation of stones. It should be built individually, taking into account the chemical composition of the stones and the reaction of urine. Diet therapy should be similar to that for the corresponding diathesis (see "Uric acid diathesis", "Oxalic acid diathesis", "Phosphaturia").

To enhance the diuretic effect, which promotes the discharge of small stones, in the absence of contraindications from the cardiovascular system and kidneys, it is recommended to use an increased amount of liquid: boiled water, low-mineralized mineral water. A decoction of bearberry (“bear ears”), horsetail, corn stigmas, and the use of watermelons have a diuretic effect.

Conclusion (nutrition for diseases of the kidneys and urinary tract) (PREMIUM)

Therapeutic nutrition for kidney diseases is characterized by the exclusion of table salt; restriction of liquid, simple carbohydrates (sugar); some decrease in protein (mainly of plant origin); exclusion of substances that irritate the kidneys (caffeine, alcohol, essential oils, etc.); full provision of the body's need for vitamins and minerals.

The total weight of the daily diet is 2.5 kg. The amount of fluid consumed is reduced to 1 liter per day, including the first and third courses. Diet - 4 times a day.

Dishes are cooked well boiled or chopped. Meat, poultry and fish are used boiled or followed by frying, baking. Onions and other spicy vegetables are pre-blanched. To improve the taste properties of culinary products, various seasonings are used: lemon zest and juice, wine or apple vinegar, tomatoes, vegetable juices, cinnamon, bay leaf.

The following products and methods of their culinary processing are recommended.

Bread - mostly wheat from flour of the 1st and 2nd grades, salt-free and bran, biscuit, cookies are not rich.

Cold dishes - salads from raw and boiled vegetables with vegetable oil; meat, chickens, fish in boiled form or in the form of jellied dishes on vegetable broths.

Soups (half serving - 250 g) - dairy; filling on vegetable, cereal broths; sweet on fruit and berry decoctions.

Meat dishes - lean beef, veal; poultry (chickens, turkeys), boiled rabbit or followed by frying or baking, chopped or in pieces.

Fish dishes - boiled or baked (after boiling) form.

Eggs are used mainly in the composition of dishes no more than 1 pc. a day or in the form of a protein omelet. Milk and sour-milk products - whole milk or, in case of poor tolerance, diluted, kefir, yogurt, acidophilus, cottage cheese (mostly low-fat). Sour cream and cream are limited.

Dishes and side dishes from vegetables - all kinds of vegetables (except sorrel, spinach, turnip, radish) in raw, boiled and baked form.

Cereal and flour products - from any kind of cereals and pasta. Legumes (other than soy) are excluded.

Sweet dishes - any fruits and berries in raw, boiled and baked form; watermelon melon. Sugar, honey, jam and other sweets - in limited quantities.

Sauces - sour cream, dairy, on vegetable broths, sweet.

Drinks (taking into account the rate of free liquid) - weak tea, tea with milk, coffee drinks, fruit and vegetable juices, rosehip broth, wheat bran infusion. Carbonated drinks are excluded.

Fats - unsalted butter, mainly vegetable oils.

 

Forbidden: meat and fish broths; salty foods and dishes; meat and fish gastronomic products; animal fats - mutton, beef, pork; rich and flour confectionery; strong tea, cocoa; carbonated drinks.

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