Author: Manminder

The hemodialysis diet is an eating plan tailored to patients who are on hemodialysis. It’s designed to reduce the amount of fluid and waste that builds up between hemodialysis treatments so that you can feel your best.

• Eat more high protein foods.
• Eat less high salt, high potassium, and high phosphorus foods.
• Learn how much fluid you can safely drink (including coffee, tea, and water).

Salt & Sodium

• Use less salt and eat fewer salty foods: this may help to control blood pressure and reduce weight gains between dialysis sessions.
• Use herbs, spices, and low-salt flavor enhancers in place of salt.
• Avoid salt substitutes made with potassium.

Meat/Protein
People on dialysis need to eat more protein. Protein can help maintain blood protein levels and improve health. Eat a high protein food (meat, fish, poultry, fresh pork, or eggs) at every meal, or about 8-10 ounces of high protein foods every day.

Grains/Cereals/Bread
Unless you need to limit your calorie intake for weight loss and/or manage carbohydrate intake for blood sugar control, you may eat, as you desire from this food group. Grains, cereals, and breads are a good source of calories. Most people need 6 -11 servings from this group each day.

Milk/Yogurt/Cheese
Limit your intake of milk, yogurt, and cheese to ½-cup milk or ½-cup yogurt or 1-ounce cheese per day. Most dairy foods are very high in phosphorus. The phosphorus content is the same for all types of milk – skim, low fat, and whole!If you do eat any high-phosphorus foods, take a phosphate binder with that meal.

Dairy foods “low” in phosphorus:

• Butter and tub margarine
• Cream cheese
• Heavy cream
• Ricotta cheese
• Brie cheese
• Non-dairy whipped topping
• Sherbet

If you have or are at risk for heart disease, some of the high-fat foods listed above may not be good choices for you.

Fruit/Juice
All fruits have some potassium, but certain fruits have more than others and should be limited or totally avoided. Limiting potassium protects your heart.

Drinks:

• Apple cider
• Grape juice
• Cranberry juice cocktail
• Lemonade

Vegetables/Salads
All vegetables have some potassium, but certain vegetables have more than others and should be limited or totally avoided. Limiting potassium intake protects your heart.Your hemodialysis diet will include a balance of nutrients to help keep your body healthy and strong while allowing the amount of potassium, phosphorus and sodium your body can safely handle.

Glomerulonephritis (GN), also known as glomerular nephritis, is a term used to refer to several kidney diseases (usually affecting both kidneys). Many of the diseases are characterized by inflammation either of the glomeruli or of the small blood vessels in the kidneys, hence the name, but not all diseases necessarily have an inflammatory component.

As it is not strictly a single disease, its presentation depends on the specific disease entity: it may present with isolated hematuria and/or proteinuria (blood or protein in the urine); or as a nephrotic syndrome, a nephritic syndrome, acute kidney injury, or chronic kidney disease.

There are two types of glomerulonephritis—acute and chronic. The acute form develops suddenly. The chronic form may develop silently (without symptoms) over several years. It often leads to complete kidney failure.

Causes acute glomerulonephritis
The acute disease may be caused by infections such as strep throat. It may also be caused by other illnesses, including lupus, Goodpasture’s syndrome, Wegener’s disease, and polyarteritis nodosa. Early diagnosis and prompt treatment are important to prevent kidney failure.

Causes chronic glomerulonephritis
Sometimes, the disease runs in the family. This kind often shows up in young men who may also have hearing loss and vision loss. Some forms are caused by changes in the immune system. However, in many cases, the cause is not known. Sometimes, you will have one acute attack of the disease and develop the chronic form years later.

Symptoms of Glomerulonephritis
Acute GN
Early symptoms of acute GN include:

• puffiness in the face (edema)
• urinating less often
• blood in your urine (dark, rust-colored urine)
• extra fluid in your lungs, causing coughing
• high blood pressure

Chronic GN
The chronic form of glomerulonephritis can creep up without any symptoms. There may be slow development of symptoms similar to the acute form. Some symptoms include:

• blood or excess protein in your urine, which may be microscopic and show up in urine tests
• high blood pressure
• swelling in ankles and face (edema)
• frequent nighttime urination
• bubbly or foamy urine (from excess protein)
• abdominal pain
• frequent nosebleeds

Hyperkalemia is the medical term that describes a potassium level in your blood that’s higher than normal. Your body needs potassium. It is an important nutrient that is found in many of the foods you eat. Potassium helps your nerves and muscles, including your heart, work the right way. But too much potassium in your blood can be dangerous. Your blood potassium level is normally 3.6 to 5.2 millimoles per liter (mmol/L).

Causes:
A report of high blood potassium isn’t true hyperkalemia. Instead, it may be caused by the rupture of blood cells in the blood sample during or shortly after the blood draw. The ruptured cells leak their potassium into the sample. This falsely raises the amount of potassium in the blood sample, even though the potassium level in your body is actually normal. When this is suspected, a repeat blood sample is done.
The most common cause of genuinely high potassium (hyperkalemia) is related to your kidneys, such as:

• Acute kidney failure
• Chronic kidney disease

Other causes of hyperkalemia include:

• Addison’s disease (adrenal failure)
• Alcoholism or heavy drug use that causes rhabdomyolysis, a breakdown of muscle fibers that results in the release of potassium into the bloodstream
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Destruction of red blood cells due to severe injury or burns
• Excessive use of potassium supplements
• Type 1 diabetes

Symptoms:
The symptoms of an elevated potassium level are nonspecific, and generally include malaise, palpitations, and muscle weakness. If symptoms do appear, they are usually mild and non-specific. You may feel some muscle weakness, numbness, tingling, nausea, or other unusual feelings. It usually develops slowly over many weeks or months and is often mild. It can recur.

If hyperkalemia comes on suddenly and you have very high levels of potassium, you may feel heart palpitations, shortness of breath, chest pain, nausea, or vomiting. Sudden or severe hyperkalemia is a life-threatening condition. It requires immediate medical care.

Hemolytic uremic syndrome, or HUS, is a kidney condition that happens when red blood cells are destroyed and block the kidneys’ filtering system. The damaged red blood cells clog the filtering system in the kidneys, which can lead to life-threatening kidney failure. If the kidneys stop functioning, a child can develop acute kidney injury. The sudden and temporary loss of kidney function. Hemolytic uremic syndrome is the most common cause of acute kidney injury in children. Red blood cells contain hemoglobin—an iron-rich protein that gives blood its red color and carries oxygen from the lungs to all parts of the body.

HUS usually develops in children after five to 10 days of diarrhoea — often bloody — caused by infection with certain strains of Escherichia coli (E. coli) bacteria. Adults also can develop HUS due to E. coli or other types of infection, certain medications, or pregnancy.

HUS is a serious condition. But timely and appropriate treatment leads to a full recovery for most people, especially young children.

Symptoms
Signs and symptoms of HUS can include:

• Bloody diarrhea
• Decreased urination or blood in the urine
• Abdominal pain, vomiting and occasionally fever
• Pallor
• Small, unexplained bruises or bleeding from the nose and
• Fatigue and irritability
• Confusion or seizures
• High blood pressure
• Swelling of the face, hands, feet or entire body

Symptoms of hemolytic uremic syndrome in children:
A child with hemolytic uremic syndrome may develop signs and symptoms similar to those seen with gastroenteritis—an inflammation of the lining of the stomach, small intestine, and large intestine such as,

• Vomiting
• Bloody diarrhea
• Abdominal pain
• Fever and chills
• Headache

Risk Factors
The risk of developing HUS is highest for:

• Children under 5 years of age
• People over 75
• People with certain genetic changes that make them more susceptible

Complications
HUS can cause life-threatening complications, including:

• Kidney failure, which can be sudden (acute) or develop over time (chronic)
• High blood pressure
• Stroke
• Coma
• Intestinl problems, such as inflammatory colitis
• Heart problems

Diagnosis
A health care provider diagnoses hemolytic uremic syndrome with

• A medical and family history
• A physical exam
• Urine tests
• A blood test
• A stool test
• Kidney biopsy

A common misconception is that everyone should drink eight glasses of water per day, but since everyone is different, daily water needs will vary by person. How much water you need is based on differences in age, climate, exercise intensity, as well as states of pregnancy, breastfeeding, and illness. If you become dehydrated, then it is more difficult for this delivery system to work. Severe dehydration can lead to kidney damage, so it is important to drink enough when you work or exercise very hard and especially in warm and humid weather.

6 ways – Water keeps your Kidneys Healthy

• At least 8 glasses a day:

There is no hard rule that everyone needs 8 glasses of water a day. This is just a general recommendation based on the fact that we continually lose water from our bodies. It is estimated that men need approximately 13 cups (3 litres) of fluid daily and that women need approximately 9 cups (2.2 litres) of fluid daily.

• For end-stage kidney disease:

When the kidneys fail, people don’t excrete enough water, if any at all. For those who are receiving dialysis treatment, water must actually be greatly restricted.

• Reduce sodium level:

Though it is rare for this to happen in the average person, endurance athletes like marathoners may drink large amounts of water and thereby dilute the sodium level in their blood, resulting in a dangerous condition called hyponatremia.

• Your urine can reveal a lot:

For the average person, drinking enough water or other healthy fluids, such as unsweetened juice or low-fat milk to quench thirst and to keep your urine light yellow or colourless. When your urine is dark yellow, this indicates that you are dehydrated. You should be making about 1.5 litres of urine daily (about 6 cups).

• Water helps prevent kidney stones and UTIs:

Kidney stones and urinary tract infections (UTIs) are two common medical conditions that can hurt the kidneys, and for which good hydration is essential. Kidney stones form less easily when there is sufficient water available to prevent stone-forming crystals from sticking together. Water helps dissolve the antibiotics used to treat urinary tract infections, making them more effective. Drinking enough water also helps produce more urine, which helps to flush out infection-causing bacteria.

• Beware during medication:

Drinking extra water with certain medications or before and after procedures with contrast dye may help prevent kidney damage. Read medication labels thoroughly before involving contrast dyes.

Goodpasture syndrome (GPS; also known as Goodpasture’s disease, anti-glomerular basement antibody disease, or anti-GBM disease) is a rare autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs and kidney failure. It is thought to attack the alpha-3 subunit of type IV collagen, which has therefore been referred to as Goodpasture’s antigen. Goodpasture syndrome may quickly result in permanent lung and kidney damage, often leading to death.

Signs and Symptoms
The anti-glomerular basement membrane (GBM) antibodies primarily attack the kidneys and lungs, although, generalised symptoms like malaise, weight loss, fatigue, fever, and chills are also common, as are joint aches and pains

Lung symptoms usually antedate kidney symptoms and usually include: coughing up blood, chest pain, cough, and shortness of breath. Kidney symptoms usually include blood in the urine, protein in the urine, unexplained swelling of limbs or face, high amounts of urea in the blood, and high blood pressure.

Causes
Its precise cause is unknown, but an insult to the blood vessels taking blood from and to the lungs is believed to be required to allow the anti-GBM antibodies to come into contact with the alveoli.

• Exposure to organic solvents (e.g. chloroform) or hydrocarbons
• Exposure to tobacco smoke
• Certain gene mutations (HLA-DR15)
• Infection, such as influenza A
• Cocaine inhalation
• Metal dust inhalation
• Bacteraemia
• Sepsis
• High-oxygen environments
• Treatment with anti-lymphocytic

What are cystine stones?
A cystine stone is a type of kidney stone. Many people think there is only one type of kidney stone. But in fact, there are different types. A kidney stone is a solid piece of material that forms in a kidney. It may stay in the kidney or travel down the urinary tract.

Cystine stones tend to reoccur and are typically larger than other kidney stones. You should talk to your healthcare provider if you get cystine stones. There are things you can do to lessen your risk of forming new stones. You may not know you have a cystine stone. It is important to have stones diagnosed to help get the right treatment for this condition.

Causes
Cystine stones are caused by a rare disorder called “cystinuria.” The disorder causes a natural substance called “cystine” to leak into your urine. When there is too much cystine in the urine, kidney stones can form. These stones can get stuck in the kidneys, bladder, or anywhere in the urinary tract. Most people with cystinuria have recurring stones. It is a lifelong condition that can be controlled, but not cured.

Who is at risk for cystinuria?
Cystinuria is an inherited disorder. Inherited means it is passed down from parents to children through a defect in a specific gene. In order to have cystinuria, a person must inherit the gene from both parents. About 1 in 7,000 people worldwide have cystinuria. According to a recent study, most people with cystinuria get their first stones in their twenties or thirties with 30-40% of people developing cystine stones in their teens. But some adults have their first cystine stone after age 40. Children can also get cystine stones. In fact, according to some research, 8-10% of kidney stones in children are cystine stones.

What is hematuria?
Hematuria means that red blood cells are in the urine. Urine does not normally contain red blood cells because the filters in the kidney prevent blood from entering the urine. In hematuria, the filters or other parts of the urinary tract allow blood to leak into the urine. Microscopic hematuria means that the blood is detected only with a microscope, while Macroscopic hematuria means the urine appears red or the color of tea or cola. Microscopic hematuria in an otherwise healthy child does not usually need to be investigated unless it is present in at least three urine tests over several months. However, if the child has high blood pressure, chronic kidney disease or protein in the urine, then hematuria should be investigated promptly

What causes hematuria?
Hematuria is a common finding in children and has more than 100 different causes. These causes may include:

• abnormal structures in the urinary tract
• inherited diseases
• mineral imbalances in the urine
• glomerulonephritis
• in some cases, no cause of hematuria may be found.

How is hematuria evaluated?
Children who have microscopic hematuria with normal blood pressure and kidney function should have their urine checked over several months. If blood in the urine continues:

• A kidney ultrasound may be performed
• Urine should be checked for protein and may be checked for calcium and creatinine.
• Blood test to determine kidney function and other tests may be performed.
• If all tests are negative and blood remains in the urine, yearly checkups should be done.

Children who have microscopic hematuria with high blood pressure, abnormal blood tests, a family history of kidney disease or high levels of protein in the urine may need to have a kidney biopsy.

Making healthy food choices is important to us all, but it is even more important if you have kidney disease. Proper nutrition gives you energy to do your daily tasks, prevents infection, builds muscle, helps maintain a healthy weight, and can keep your kidney disease from getting worse. Is it possible to maintain a vegetarian diet after being diagnosed with kidney disease? The answer is yes. With careful planning, vegetarianism, or even part-time vegetarian eating, is not only safe, but also beneficial to kidney disease patients.

A healthy eating plan gives you the right amount of protein, a proper balance of sodium, potassium and phosphorus, and vitamins/minerals when needed. Let’s take a closer look at general nutritional guidelines for those with early kidney disease (30-50% of normal kidney function) who are not receiving dialysis treatments. Always check with your doctor or dietitian for specific concerns.

Protein
Protein is an important nutrient. Your body needs protein to help build muscle, repair tissue and fight infection. As a kidney patient, you may need to closely monitor the protein you eat to prevent wastes from building up in the blood. Keeping to .8 gram (g) of protein per kilogram (kg) body weight is recommended, with approximately two-thirds of this protein coming from quality plant protein or animal/plant combination, such as the following:

Quality Protein	Serving Size = 7 g protein
Egg	1
Veggie type burger	½ to 1
Seitan (Wheat gluten)	1 oz.
Beans, dried cooked	1/3 – 1/2 cup
Tofu	¼ – ½ cup
Tempeh	¼ cup
Nut Butters	2 tablespoons
Meat, Fish, Poultry	1 oz.
Cottage Cheese	¼ cup

Sodium Though vegetarian foods are healthy in general, some can be very high in sodium. Use as many fresh foods as possible and limit your use of the following:
Convenience foods such as frozen meals, canned soup, dried soups, miso or packaged vegetable broths Soy-based cheese
Processed dairy cheese
Meat analogues — this includes such foods as tofu hot dogs, veggie burgers or other canned or frozen soy products Salt, soy sauce, tamari sauce or any spices that contain the words sodium or salt

Potassium In general, potassium does not need to be restricted unless the function of the kidney decreases to less than 20% or levels in the blood are found to be high. Routine blood testing is the best way to know your potassium requirements. An estimated two-thirds of diet potassium comes from fruits, vegetables and juices. So if your level of potassium is elevated, try to minimize fruit and vegetable selections to five servings per day.
A potassium serving size:
1/2 cup fresh fruit, canned fruit or juice
1 cup fresh vegetables
1/2 cup cooked vegetables
If this does not decrease your serum potassium to the normal range, limit these foods:

High Potassium Limit 1 per day
Textured vegetable protein	1/4 cup
Soy flour	1/4 cup
Nuts and Seeds	1/4 cup
Dried, cooked beans or lentils	1 cup
Dried cooked soybeans	1/2 cup
Tomato products	1/4 cup
Potatoes	1/2 cup
Dried fruit	1/4 cup
Tropical fruit	1/2 cup
Melons	1/2 cup

If you use a lot of beans or textured vegetable protein, alternative protein selections may be needed in order to keep potassium levels from going too high. This will mean using more tofu, tempeh, seitan and eggs or, if you prefer, some meat, fish or poultry to meet protein needs.

Phosphorus
Dairy products, dark colas and processed foods, even vegetarian processed foods, can be a source of concentrated phosphorus. To keep your phosphorous in a healthy range, avoid dark colas, and processed foods containing phosphate additives. In addition, limit the following foods:

High Phosphorus Limit 1 per day
Milk	1 cup
Cheese	2 ounces
Pudding or custard	8 ounces
Yogurt	8 ounces
Soy cheese	4 ounces
Soy yogurt (non fortified)	12 ounces

•  Rice milk and up to two cups of soymilk per day can be used as a replacement for milk. Avoid commercial non diary creamers as most contain phosphate additives.

Grains, breads and cereals
Whole grains are a means to fill out your diet with many healthy nutrients and fiber. Even though many whole grains are slightly higher in phosphorous than white breads and grains, the whole grains phosphorus is absorbed less efficiently. This is because of substance called phytates in whole grains that keep the phosphorus from being absorbed. White grains are more processed and do not have phytates and the phosphrous is absorbed almost 100%, while whole grains are only absorbed at 20-50%. So fill your diet out with at least 6 servings of whole grains per day. Good selections are whole grain pastas, brown rice, barley, quinoa, millet, couscous and amaranth.

Vitamins and Minerals
Almost all vitamins and minerals come from the foods you eat. Your body does not make these substances. People with healthy kidneys who eat a variety of foods from all the food groups can get lots of vitamins and minerals. Your kidney diet limits some food groups; therefore, you may not be getting all the vitamins and minerals you need each day. It may be important for you to take certain amounts of some vitamins and minerals in the form of supplements.

Most people will require a water-soluble vitamin without fat-soluble vitamins or minerals. Mineral levels will need to be checked individually to determine if a supplement is needed. Speak to your kidney doctor or dietitian. They can help you learn about vitamins and mineral supplements that could be necessary if you have kidney disease.

If you need help planning meals, your doctor can refer you to a registered dietitian with special training in kidney disease. A dietitian can help you choose foods that will give you the right nutrients in the right amounts, explain why diet changes you need to make are important.