Renal failure complicates the course of many diseases of the excretory system. Treatment for this condition should be comprehensive and include not only taking medications, but also following the doctor’s lifestyle recommendations. What should the diet be like for kidney failure? We’ll talk about acceptable and prohibited foods, as well as the general diet plan, in our review.
Who might encounter this problem?
It is important to understand that kidney failure is not a separate disease, but a syndrome that has many different causes. The acute form of the pathology develops when:
- disruption of blood circulation in the vascular bed caused by heart failure, arrhythmia, shock, etc.;
- massive death of nephrons (functional units of kidney tissue);
- pathologies causing acute disruption of urine outflow.
Chronic renal failure (CRF) is often a consequence of sluggish pathology of the urinary organs - pyelonephritis, glomerulonephritis, urolithiasis. Often this condition is diagnosed against the background of diabetes mellitus, rheumatism, gout and other metabolic disorders.
The name of the disease speaks for itself. In case of renal failure, a violation of all functions of the urinary system organs develops:
- excretory;
- osmoregulatory;
- ion-regulating;
- intrasecretory;
- metabolic.
A diet for renal failure can reduce the negative impact of unresolved metabolic products on the body and reduce the increased load on the gastrointestinal tract. Proper nutrition “helps” the kidneys work better and reduces the risk of developing possible complications.
Basics of therapeutic nutrition
Specialized nutrition for renal failure is called therapeutic diet number 7 (Pevzner table). It is aimed at:
Reducing the amount of protein consumed to 40-60 grams per day. In large quantities, protein metabolic products in the body have a toxic effect and “load” the kidneys with unnecessary work. Providing a person with all nutrients This is done mainly through dairy and plant foods rich in fats, carbohydrates and easily digestible protein. Limiting salt to 1 g/day Salt has the ability to retain water in the vascular bed. Drinking regimen agreed with the doctor Patients with renal failure may have to limit fluid intake to 1.0-1.2 liters per day. Optimal culinary processing All products are recommended to be consumed boiled, stewed, baked or steamed. 
What can you eat if you have kidney failure? Among the permitted products are:
- cereals: rice, buckwheat, sago;
- yeast-free bread;
- light soups with vegetable broth;
- lean meat (chicken breast, turkey, rabbit, veal);
- fish;
- seasonal vegetables (carrots, beets, potatoes, pumpkin, turnips, tomatoes), herbs;
- eggs (no more than one per day);
- processed fruits in the form of jam, preserves, jelly, mousse, etc.
Prohibited for illness:
- alcohol in any form;
- strong coffee, tea, cocoa, hot chocolate;
- excessively salty dishes, pickled vegetables;
- mushrooms;
- foods rich in saturated fatty acids and trans fats (pork and beef fat, kidneys, brains, tongue and other offal, margarine, cooking fat);
- vegetables and fruits that cause increased gas formation in the intestines (cabbage, spinach, peas, beans and other legumes, bananas, apricots);
- canned food and sausages.
Diet for acute kidney failure
The diet for acute renal failure should be aimed at facilitating the functioning of the excretory system and preventing the development of complications. The situation is complicated by the fact that at an early stage of the disease, patients are usually unconscious and require parenteral nutrition. Then, as vital functions are restored, they can be transferred to a therapeutic diet.
The main principle of nutritional correction in acute renal failure remains limiting protein intake to 40-70 g/day. At the same time, the total caloric content of the diet should remain relatively high in order to avoid destruction of the body’s own tissues and increased stress on the kidneys.
This is achieved through complex carbohydrates contained in cereals, fruits and vegetables, as well as fats rich in healthy omega-3, 6.
When replenishing the supply of nutrients, vitamins and microelements, the following are considered especially useful:
- freshly squeezed juices - apple, cherry, plum, melon;
- vegetables - potatoes, carrots, cauliflower, beets;
- fresh greens.
With proper treatment, complete recovery of patients with acute renal failure occurs within 6-24 months. Following a diet during this period is very important for a speedy recovery and normalization of kidney function. In the future, the patient can gradually expand the list of permitted products.
Diet for chronic renal failure
A diet for chronic renal failure must be followed by the patient throughout his life. At the initial stage of the disease, a slight restriction of protein in the diet is assumed - up to 1 g / kg of weight.
- cereals and bread;
- vegetables;
- nuts.
It is important for patients with chronic renal failure to consume sufficient amounts of nutrients, so the caloric content of food should be high. There is no need to greatly limit salt, but its amount per day should not exceed 3-4 grams.
The amount of liquid allowed for consumption during the day should be agreed with the attending physician. Standard instructions recommend drinking 500 ml more water than was excreted in urine the entire previous day.
- watermelon;
- apples;
- pumpkin
The diet for severe insufficiency of the organs of the excretory system becomes more strict. The amount of protein consumed daily is limited to 20-25 g, and 70-80% of this amount should be easily digestible animal food - lean meat, fish, poultry, eggs. Salt is limited to 3 g/day if there is no edema.
If symptoms of renal failure increase, it is recommended to switch to a completely salt-free diet. To prevent food from seeming bland, you can use spices (except hot ones - pepper, mustard, horseradish), herbs, herbs, lemon juice.
The daily menu for patients with chronic renal failure may look like this:
Breakfast
- Boiled potatoes;
- one egg omelette;
- Orange juice.
- natural yogurt with berry puree;
- mineral water.
- vegetable soup with buckwheat;
- stew of eggplant, bell pepper and carrots;
- apple jelly.
- rye bread with butter;
- rosehip decoction.
- rice porrige;
- jam;
- plum juice
Diet remains one of the common methods of treating serious diseases of the urinary system: in case of renal failure, it is not difficult to follow, because its menu is quite varied and its calorie content is high. Compliance with medical recommendations significantly improves the patient’s prognosis and reduces the severity of symptoms of the pathology.
Diet for chronic renal failure (CRF) at the predialysis stage
Nutrition in chronic renal failure in conditions of decreased kidney function is of particular importance; regular monitoring of nutritional status, keeping food diaries, and consulting a nutritionist are important.
Patients with chronic renal failure need a balanced diet; the slightest excess in nutrition leads to aggravation of metabolic disorders caused by nephropathy, while at the same time, a deficiency of essential amino acids and insufficient caloric intake lead to protein-energy malnutrition syndrome.
Nutrition for patients with chronic renal failure
The diet of patients with chronic renal failure should be complete and contain a large amount of vegetables and fruits. By-products, canned food, food concentrates, instant foods and semi-finished products should be excluded.
Patients with overweight , obesity, hyperlipidemia, decreased tolerance to carbohydrates, it is necessary to limit the daily calorie intake to 1200-1400 kcal.
In case of chronic renal failure in combination with overweight and obesity, sugar, white bread, pastry, sweets and other sweets, mayonnaise, butter and palm oil, other fatty dairy products (soft cheeses, sour cream, cream) should be excluded from the diet. ice cream, fatty meat and poultry, soups with fatty broth and other high-calorie foods.
Patients with disorders of purine metabolism (hyperuricemia and hyperuricosuria) should be excluded: rich broths, offal - liver, kidneys, heart, tongues, etc., pates, sausages, veal, pork, chicken, smoked meats, canned meat and fish, instant foods, legumes ( green peas, beans, beans, lentils), cocoa, chocolate, nuts, strong tea and coffee, grapes, raisins, grape wines.
At disorders of oxalic acid metabolism (oxaluria, oxalate kidney stones, oxalosis) in addition to the restrictions indicated for increased uric acid, greens, sorrel, spinach, rhubarb, and peppers should also be limited.
At hyperphosphatemia the same foods are excluded as in case of a violation of purine metabolism, and additionally fish should be limited (no more than once a week), as well as cereals (except rice) and other foods rich in phosphorus. Daily phosphorus intake should not exceed 800 mg/day. Artificial sago (a product made from starch) can be used as a cereal substitute. Sago is added to first courses and used to make porridges, puddings, meatballs, and pie fillings.
For the purpose of correction hyperkalemia It is recommended to limit the same foods as in case of violation of purine metabolism, as well as dried apricots, figs, bananas, apricots, peaches, nectarines, etc. Limit potatoes (up to 2-3 times a week) and prepare them in a special way: peel, cut , soak in water for at least 3 hours, drain the water and boil the soaked potatoes in fresh water.
Low protein diet for chronic renal failure
A low-protein diet in chronic renal failure and chronic kidney disease plays a key role and is used to reduce the accumulation of nitrogenous waste and reduce uremic intoxication. Recommendations for limiting protein intake are based on data that this reduces the content of uremic substances - products of protein metabolism, and that some amino acids that enter the blood during the digestion of protein foods increase glomerular perfusion and aggravate glomerular hypertension and increase proteinuria.
The benefits of a low-protein diet are evidenced by clinical studies that have proven that a low-protein diet:
- reduces proteinuria;
- delays the onset of ESRD (end-stage renal failure);
- improves renal hemodynamics;
- increases the effectiveness of antihypertensive drugs;
- improves purine metabolism;
- helps correct hyperphosphatemia and prevent metabolic acidosis.
A low-protein diet (LPD) also has additional beneficial effects: it increases sensitivity to antihypertensive therapy, insulin, and increases the antiproteinuric effect of ACE inhibitors. Patients who strictly follow protein restriction recommendations improve their health and slow down the progression of renal failure.
How much protein can patients with chronic renal failure?
The degree of protein restriction must be adequate stage of chronic renal failure(0.7–0.8 g/kg body weight per day with a moderate decrease in GFR, 0.6 and, in some cases, lower - up to 0.3 g/kg/day with a pronounced decrease in function).
In most cases, a moderate low-protein diet is recommended (0.6-0.8 g/kg/day), but at least 60% of the protein must be of high biological value, that is, contain a sufficient amount of essential amino acids; Adequate calorie intake is required - 30-35 kcal/kg/day.
However, due to the possible inadequate implementation of the diet by patients or the deterioration and perversion of appetite (aversion to meat foods), which is often observed with severe chronic renal failure, the risk of developing protein-energy deficiency syndrome, which is characterized by impaired synthesis of vital proteins, hypercatabolism of muscle and other body proteins, an increase in the level of nitrogenous waste and potassium, and an increase in the mortality of patients.
Therefore, with a low-protein diet, a ready-made medicinal preparation of all essential amino acids and their keto analogues is prescribed (Ketosteril), which provides reliable prevention of protein-energy deficiency syndrome. Keto analogues do not contain an amino group, which reduces the nitrogen load.
A more strict low-protein diet (but not lower than 0.3 g/kg/day) is permissible only if there are technical and organizational capabilities for expanded and regular monitoring of nutritional status, and is combined with the mandatory intake of essential keto analogues of essential amino acids.
How much salt can you consume if you have chronic renal failure?
Limiting salt intake (no more than 5 g/day, and, if possible, even stricter) is of fundamental importance for adequate correction of arterial hypertension and increases the antiproteinuric effectiveness of ACE inhibitors and angiotensin receptor blockers. Food should be prepared without adding salt and not added to the table.
If you are intolerant to a strict salt-free diet, you can add a little salt to the prepared dishes on the plate (no more than 1 g per day - that is, on the tip of a knife). If there are no contraindications from the gastrointestinal tract, you can use spices and herbs so that the food does not seem bland. The exception is tubular lesions with increased sodium excretion.
Principles of nutrition for chronic renal failure
Nutrition for chronic renal failure should be regular, if possible, frequent - 3 main meals plus 2 light snacks.
Patients with chronic renal failure or chronic kidney disease should adhere to the following dietary principles:
- balanced, nutritious diet;
- adequate calorie intake;
- monitoring nutritional status, keeping diaries, training;
- ensuring sufficient intake of calories into the body (30-35 kcal/kg body weight), essential amino acids;
- strict salt restriction - no more than 4-5 g/day;
- restriction of protein intake (0.8-0.3 g/kg/day, according to the stage of chronic renal failure);
- adequate water regime;
- correction of hyperlipidemia and hyperglycemia;
- correction of purine metabolism disorders;
- correction of phosphorus-calcium metabolism disorders;
- prevention and correction of hyperkalemia;
- starting from stage 3B, sometimes earlier - correction of metabolic acidosis.
The water regime is determined by the specific clinical situation. Most patients with chronic renal failure are shown an extended water regimen, that is, at least 2 liters. liquids per day in cool weather, up to 3 liters. fluids per day in hot weather, especially with urolithiasis, disorders of purine metabolism, and a tendency to urinary infection. With nephrotic syndrome, decreased diuresis, on the contrary, fluid intake should be sharply limited.
Protein-energy malnutrition syndrome
Dangerous: deficiency of calories and essential amino acids, impaired synthesis of vital proteins, sudden weight loss, loss of muscle mass, fatty tissue, paradoxical increase in nitrogenous waste, hyperkalemia.
Required: adequate diet, special nutritional mixtures, preparations of essential amino acids and their keto analogues (Ketosteril).
Restrictions for chronic renal failure
- hypothermia and dampness, prolonged exposure to the sun;
- overload and psychological stress, lack of sleep;
- alcohol abuse, drug use;
- independent, without the consent of a doctor, taking medications or nutritional supplements;
- the use of analgesics and NSAIDs (non-steroidal anti-inflammatory drugs) should be limited as much as possible - no more than 1 tablet per month if complete exclusion is not possible;
- professional and household frequent contacts with paints, varnishes, organic solvents, heavy metals; for occasional contacts it is necessary to use protective equipment.
Physical education for chronic renal failure and prevention
We must not forget about the importance of dosed physical activity, mainly aerobic (swimming, brisk walking, exercise on an exercise bike and elliptical trainer), which is necessary to optimize weight, blood pressure, and reduce the risk of cardiovascular complications.
At the same time, jogging, exercise on a treadmill, horse riding and other exercises associated with significant shaking of the body are undesirable for people prone to kidney prolapse.
Physical education classes should be regular and evenly distributed throughout the week. If possible, at least 30 minutes a day or an hour 3 times a week.
An important component of nephroprotective therapy is the patient’s cessation of smoking, which is a significant cause of the development of endothelial dysfunction, impaired renal hemodynamics and the progression of nephrosclerosis.
Kidneys play an important role in the functioning of the human body. For the normal functioning of this organ, it is necessary to adhere to certain nutritional rules. Diet for kidney failure is considered a mandatory part of treatment. Without this component of therapy, there can be no talk of improving a person’s condition.
This disease is very dangerous for health and life, so you need to take it seriously. The doctor will tell you what you can eat and what you cannot eat if this disease is diagnosed in the patient. Kidney failure is a condition in which the kidneys do not perform their functions, the body's metabolic processes are disrupted, water, nitrogen, electrolytes, all of this cannot be removed from the human body. Such disorders can result from many diseases.
Note! It is important to consider that kidney failure can be acute and chronic, each type requires its own diet.
In addition to diet, the treatment of this disease includes some procedures and medications - such therapeutic manipulations are aimed at restoring the functions of this organ.
Nutritional Features
Dietary restrictions in case of renal failure should be aimed at reducing the load on the kidneys to ensure their normal functioning. There are certain standards that must be adhered to. Protein should be consumed in an amount of 60-40g per day, a mandatory supply of amino acids to the body is also necessary, and salt should be almost completely eliminated - the daily amount of salt should not exceed 1 g.
In addition, nutrition for renal failure is adjusted depending on the individual characteristics of the person. Despite the fact that the amount of protein consumed should be low, the body needs fats and carbohydrates in large quantities. Bread is definitely included in the diet of such patients, but only corn or wheat.
We must not forget about the regular intake of vitamins, which are necessarily included in the diet for renal failure. Berries, fruits, vegetables, juices are excellent sources of these elements.
Diet therapy also eliminates the consumption of certain drinks that are irritating to the kidneys. Many people forget to pay attention to the liquid they consume, and this is very important. Strictly prohibited drinks and foods:
There is a list of certain foods that can be consumed in case of kidney failure, but the amount of such food must be agreed with the doctor, these are:
- Dried fruits.
- Caviar.
- Dairy products.
- Various nuts.
- Fatty fish.
- Sunflower seeds.
- All legumes.
The basics of nutritional therapy may vary depending on the course of the disease. If renal failure has just appeared, then dietary restrictions are strict; in the case of a chronic course of the disease, the doctor may further increase the list of prohibited foods. Recipes for medicinal dishes can be very diverse; patients with kidney failure have learned to create a menu, taking into account all dietary restrictions.
Basic principles of diet No. 7
There is a certain type of diet for such patients - this is diet 7. The list of prohibited and healthy foods that are included in this dietary menu helps relieve irritation from the kidneys and improve their functioning. If a doctor prescribes diet number 7, you need to study it carefully, understand what you can and cannot eat.
Features of diet number 7:
It is quite possible to prepare delicious dishes from such products. The doctor will tell you about the features of such a diet and the duration of its adherence.
Important! If a patient with chronic renal failure has a concomitant disease, such as diabetes, then the diet needs to be adjusted.
The following should be excluded from the diet of patients with diabetes and renal failure:
In the case of diabetes mellitus and kidney failure, the doctor regulates the diet of such a patient, since this situation is considered very serious. In case of diabetes, carbohydrates are prohibited; this element increases blood glucose, which must be taken into account.
How to create a menu taking into account diet No. 7?
An approximate menu for the day will allow a person with chronic renal failure (CKD) to diversify their diet. Many people look for recipes on the Internet or in special magazines; you need to carefully consider such a menu and study it in detail to identify prohibited products.
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Everyone can create various dishes on their own, you just need to show your imagination. The diet for chronic renal failure is usually more strict, since the human body is already quite weakened.
If the disease continues for a long period, the disorders that arise due to poor kidney function destroy all systems and organs of the body.
Many people are concerned about the variety of healthy and permissible foods for this disease. For example, dried fruits and bananas are considered very healthy foods, but their inclusion in the menu of patients with kidney failure is prohibited. The answer lies in the composition of such products. The fact is that during the course of this pathology, the human body is not able to remove potassium that enters the bloodstream. Bananas, as well as dried fruits, are rich in this substance, so you cannot saturate it with potassium even more.
The preparation of therapeutic nutrition is based not only on improving the functioning of a specific organ, but also on stabilizing the condition of the entire organism. Doctors are developing special recommendations to improve the health of people with various diseases. Therefore, in case of kidney failure, following such a menu is extremely important, otherwise the disease will only progress, which can lead to death.
Therapeutic nutrition is prescribed simultaneously with anti-inflammatory, desensitizing and symptomatic therapy.Basic requirements for the dietary diet of patients with acute diffuse glomerulopephritis: 1) limitation of table salt and water; 2) limiting simple carbohydrates; 3) protein restriction; 4) reducing the calorie content of the diet, taking into account the level of energy expenditure of the body; 5) exclusion of extractive substances from the diet and full provision of the patient’s body’s needs for vitamins and minerals.
Based on clinical experience, it is most advisable to prescribe sodium-free nutrition to patients with acute diffuse glomerulonephritis in the first 2-3 days in the form of contrast days, the choice of which is determined by the patient’s tastes and his tolerance of technical foods and dishes. In this case, potato, apple, watermelon, pumpkin, or bapap, sugar, compote, kefir and other days are used. For the whole day, the patient is given 1.2 kg of boiled or baked potatoes, peeled, or 1.5 kg of ripe apples, or 1.5 kg of ripe peeled watermelon, or 150 g of sugar, or 1.5 liters of compote made from fresh fruits or dried fruits, or 1.2 kg of peeled bananas, or 1.2 kg of baked or boiled pumpkin with sugar. The total amount of product is divided into 5 servings and the patient is given 5 pas per day.
The amount of liquid recommended for the patient (rose hip decoction, diluted fruit juice, weak tea, milk, etc.) is determined as follows: 400 ml of liquid is added to the daily diuresis, i.e. if the patient excreted 500 ml of urine per day, then the allowed amount liquid during the day will be 900 ml. On watermelon and compote fasting days, the patient is not given liquid.
Prescribing sodium-free fasting days to a patient with acute nephritis in the first 2-3 days helps to reduce edema syndrome, lower blood pressure, and improve general condition. From the 3-4th day of treatment, the patient should be transferred to salt-free diet No. 76, containing 40 g of protein, 80 g of fat and 450 g of carbohydrates, with a total calorie content of 2700 kcal. Protein in this diet is introduced mainly from egg, milk and fish proteins, which are more easily absorbed by the body and contain fewer extractive substances. This protein-deficient diet is the mainstay in the treatment of patients with chronic renal failure. Approximate one-day diet menu No. 7b.
In acute diffuse glomerulonephritis, the excretory function of the kidneys, as a rule, is not significantly impaired, therefore, as the patient’s condition improves, the diet must be expanded, primarily by increasing the protein quota. At the beginning of the 3rd week of the acute period of the disease, provided that the severity of urinary syndrome decreases, the patient is transferred to salt-free diet No. 7. Chemical composition of the diet: proteins 80 g, fats 85 g, carbohydrates 450 g. Calorie content of the diet is 2900 kcal.
In table An approximate one-day menu for this diet is given.
The patient should remain on this diet until the end of his hospital stay. If, when switching to diet No. 7, the patient’s condition has worsened somewhat, it is necessary to prescribe him diet No. 76 again for 2-3 days in order to then return to diet No. 7. This “zigzag” sometimes has to be repeated twice in order to adapt the body patient to new nutritional conditions.
When the patient is discharged from the hospital and his condition is progressively improving, the amount of protein can be increased to 90 g and meat can be included in the diet mainly in boiled form, followed by baking. The content of table salt and simple carbohydrates, which have a sensitizing effect, is limited in the next 3-4 months, i.e. until the residual effects of acute nephritis are completely eliminated,
Approximate one-day menu of diet No. 7 (2881 kcal)
Name of dishes | Output, g | Proteins, g | Fats, g | Carbohydrates, g |
| First breakfast | ||||
| Soft-boiled eggs (2 pcs.) | 48 | 10,2 | 10,9 | 0,5 |
| Crumbled buckwheat porridge with butter | 90 | 4,3 | 4,8 | 25,0 |
| Tea with milk | 200 | 1,4 | 1,7 | 2,3 |
| Lunch | ||||
| Pumpkin porridge with semolina | 280 | 8,0 | 9,0 | 49,0 |
| Dinner | ||||
| Vegetarian borscht (1/2 serving) | 250 | 2,3 | 6,8 | 16,7 |
| Boiled meat | 55 | 15,9 | 3,2 | - |
| Fried potato | 125 | 2.6 | 7,9 | 30,1 |
| Fresh fruit compote | 200 | 0,3 | - | 27,8 |
| Afternoon snack | ||||
| Carrot-apple balls baked | 230 | 6,7 | 7,2 | 43,0 |
| Fruit pilaf (1/2 serving) | 90 | 1,9 | 6,1 | 38,2 |
| Apple juice | 200 | 0,8 | - | 23,4 |
| For the night | ||||
| Prune jelly | 200 | 0,5 | - | 46,9 |
| All day | ||||
| Bran bread, salt-free | 250 | 25,0 | 12,0 | 91,0 |
| Sugar | 50 | - | - | 49,9 |
| Butter | 20 | 0,12 | 16,5 | 0,18 |
| Total | 79,5 | 86,1 | 445,7 |
Therapeutic nutrition for chronic renal failure
Chronic renal failure (CRF) is a symptom complex caused by irreversible, severe damage to kidney function. Renal failure cannot be reduced only to a violation of the nitrogen excretion function of daughters and the accumulation of nitrogenous waste in the body, the toxic effect of which has long been considered the main cause of uremia. Deterioration of kidney function leads to severe changes in water and electrolyte metabolism, as well as metabolic disorders, which, along with azotemia, is of significant importance in the pathogenesis of chronic renal failure and often determines the course of uremia and its outcome.The goal of conservative therapy for chronic renal failure is to influence water and electrolyte disturbances, acidosis, cardiovascular failure, arterial hypertension and other disorders of the internal organs. Dietary therapy is an obligatory component of complex treatment of patients with chronic renal failure.
The concentration of the end products of nitrogen metabolism (residual nitrogen, urea, uric acid, creatinine, etc.) in the blood serum depends on the amount of protein supplied with food, the level of protein catabolism and the degree of renal failure. Since most patients with chronic renal failure cannot significantly improve renal function with medications alone, a low-protein diet is the only way to reduce azotemia.
Currently, dietary treatment of chronic renal failure is based on the following basic principles: 1) limiting dietary protein to 20-40-60 g per day, depending on the severity of renal failure; 2) ensuring sufficient calorie intake from fats and carbohydrates, corresponding to the body’s energy expenditure, full provision of vitamins, macro- and microelements; 3) in case of arterial hypertension, restriction of salt and water entering the body to those minimum limits at which it is possible to ensure the maintenance of normal water and electrolyte composition of the internal environment of the body. A significant restriction of protein in food can lead to a decrease in total protein in the body, which limits the formation of enzymes, antibodies, and hormones that are necessary for the normal functioning of the body. Consequently, constructing a dietary diet for a patient with chronic renal failure comes down to determining the optimal amount of protein that will not cause a dangerous increase in the content of nitrogenous wastes, and, at the same time, will not lead to the breakdown of the body’s own proteins due to protein starvation. In other words, in patients with chronic renal failure it is necessary to maintain nitrogen balance in conditions of reduced protein intake from the outside.
Therapeutic diets for patients with chronic renal failure
Based on the created protein-free products, the Institute of Nutrition of the Academy of Medical Sciences developed two versions of a low-protein diet containing 20 g of protein (diet No. 7a) and 40 g of protein (diet No. 76).In diets No. 7a and 76 3/4 protein is animal protein (meat, eggs, milk) as the most complete in terms of essential amino acids. This proportion of animal protein made it possible to provide diet No. 7a with the minimum amount of essential amino acids at which nitrogen balance is observed, and diet No. 76 - the amount of essential amino acids corresponding to the daily need for them to maintain nitrogen balance in the body of an adult (Table).
Content of essential amino acids in low-protein diets (in grams)
Caloric content of diets is provided by fats and carbohydrates, the content of which does not significantly exceed the physiological norm. When preparing diets, great attention must be paid to the taste of the diet. To improve the taste of food, it is allowed to add spices, herbs, sour vegetable and fruit juices (lemon, orange, cherry plum, tomato, etc.).Both diets are hyposodium. All food is prepared without salt; its content in the products themselves is 2-3 g per day. If the patient does not have cardiovascular failure, high blood pressure, or severe swelling, an additional 3 g of salt is given to his hands. Patients can consume 1-1.5 liters of fluid, taking into account daily diuresis. The liquid is given in the form of diluted fruit and vegetable juices, alkaline mineral water or intravenous drip infusions of 4% sodium bicarbonate solution and 5% glucose solution in case of severe intoxication.
A daily set of products included in diets No. 7a and 7b, an assortment of dishes recommended for patients with chronic renal failure, characteristics of diets and a one-day menu are given below.
Diet No. 7 a
Indications for use. Chronic kidney disease with a pronounced impairment of nitrogen excretory function and severe azotemia.Special purpose. Sparing kidney function; improving the removal of nitrogenous wastes and under-oxidized metabolic products from the body; preventing the accumulation of nitrogenous waste in the blood, slowing the development of uremia, as well as reducing hypertension.
General characteristics. A diet with the exclusion of CLR by a sharp restriction of table salt (depending on the severity of the hypertensive syndrome), a sharp restriction of protein (up to 20 g) mainly from plants, while simultaneously introducing into the body the minimum required amount of essential amino acids with complete animal protein. Avoid substances and substances that irritate the kidneys (alcohol, nitrogenous extractives, strong coffee, tea, cocoa and chocolate, spicy, salty snacks). The diet includes foods that contain a small amount of protein and are high in calories (various sago dishes, protein-free bread made from maize starch, mashed potatoes and mousses made from swelling starch). To provide the body with vitamins, give various juices (watermelon, melon, cherry, grape, etc.).
Culinary processing. All dishes are prepared without salt. Meat and fish are served boiled or then fried.
Chemical composition and calorie content of diet No. 7a. Proteins 20 g (of which 15 g are animals), fats 80 g (of which 50-55 g are animals), carbohydrates 350 g. Calorie content 2200 kcal. Table salt 1.5-2.5 g (in products). Vitamin content: retinol - 0.7 mg, carotype - 5.5 mg, thiamine - 0.45 mg, riboflavin - 0.47 mg, nicotinic acid - 4.5 mg, ascorbic acid - 268.5 mg. Mineral content: calcium - 230 mg, potassium - 1630 mg, magnesium - 100 mg, phosphorus - 390 mg, iron - 16 mg.
The total amount of free liquid is 1-1.5 liters. The weight of the daily ration is 2.3 kg. The food temperature is normal. The number of meals is 5-6 times a day.
Bread and bakery products. Protein-free bread made from maize starch, white wheat bran (achloride) is baked without salt.
Various soups, with sago, vegetables, fruits, vegetarian, prepared without salt.
Meat and poultry dishes. Lean varieties of beef, veal, chicken, turkey, rabbit, boiled and then fried, in pieces or chopped.
Fish dishes. Low-fat fish (pike perch, pike, navaga, perch, roach) boiled and then fried, sliced or chopped.
Dishes and side dishes made from vegetables and herbs. Potatoes, carrots, beets, cauliflower, lettuce, tomatoes, fresh cucumbers, parsley, green onions. Boiled, in its natural form.
Dishes and side dishes of cereals, legumes and pasta are excluded or sharply limited. Instead, they give dishes from sago and special pasta - with water and milk in the form of porridges, puddings, casseroles, cutlets, pilaf.
Egg dishes. Protein omelet and for preparing various dishes (no more than one egg per day).
Milk, dairy products and dishes made from them. Whole milk, kefir, acidophilus, yogurt, sour cream, cream (all in limited quantities).
Sauces and spices. Milk, tomato, protein-free, vegetable marinade sauce with tomato. Sweet and sour vegetable and fruit sauces with the exception of meat, fish and mushrooms
Approximate one-day menu for diet No. 7a (2440 kcal)
Name of dishes | Output, g | Proteins, g | Fats, g | Carbohydrates, g |
| First breakfast | ||||
| Sago pudding with apples | 200 | 3,2 | 6,3 | 48,0 |
| Applesauce with proteins | 140 | 1,3 | 0,9 | 41,2 |
| Apricot juice | 200 | 0,8 | 28,4 | |
| Lunch | ||||
| Fruits (apples, berries, etc.) | 100 | 0.4 | - | 11,5 |
| or melons (watermelon, melon) | 350 | 1,7 | - | 32,0 |
| Dinner | ||||
| Soup from prefabricated vegetables vegetarian (1/2 serving) | 250 | 4,8 | 9,7 |
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| Boiled meat (1/2 serving) | 26,5 | 6,95 | 1,6 | - |
| Apple, prune salad, apricots | 150 | 1,5 | 5,6 | 39,3 |
| Cranberry jelly | 200 | 0,2 | - | 38,9 |
| Afternoon snack | ||||
| Rose hip decoction | 200 | - | - | - |
| Dinner | ||||
| Sago pilaf with fruits (x/2 servings) | 90 | 0,47 | 5,92 | 40,72 |
| Vegetable salad with vegetable oil | 150 | 1,5 | 9,4 | 11,7 |
| Tea with sugar (sugar 10 g) | 200 | - | - | 9,5 |
| For the night | ||||
| Plum juice | 200 | 0,4 | - | 33,2 |
| All day | ||||
| Protein-free bread Butter Sugar | 100 60 40 | 0,83 0,36 | 2,5 49,5 | 0,5 |
| Total | 20,5 | 86,7 | 400,2 |
Approximate one-day menu of diet No. 7b (2800 kcal)
Name of dishes | Output, g | Proteins, g | Fats, g | Carbohydrates, g |
| First breakfast | ||||
| Sago pudding with apples | 270 | 4,32 | 8,58 | 65,03 |
| Applesauce with proteins | 140 | 1,3 | 0,9 | 41,2 |
| Apricot juice | 200 | 0,8 | 28,4 | |
| Lunch | ||||
| Grated raw carrots with sugar | 155 | 1,95 | - | 16,2 |
| Dinner | ||||
| Vegetarian mixed vegetable soup (1/2 serving) | 250 | 9,7 | ||
| Boiled meat | 55 | 15,9 | 3,2 | - |
| Protein-free tomato sauce | 50 | 0,5 | 3,97 | 3,7 |
| Salad of apples, prunes and apricots | 150 | 1,5 | 5,6 | 39,3 |
| Cherry puree-mousse | 140 | 0,78 | - | 20,2 |
| Afternoon snack | ||||
| Rose hip decoction | 200 | - | - | - |
| Dinner | ||||
| Sago pilaf with fruits | 180 | 0,94 | 11,84 | 81.44 |
| Protein omelet | 110 | 8,3 | 6,5 | 3,32 |
| Tea without milk | 200 | - | - | - |
| For the night | ||||
| Plum juice | 200 | 0,4 | - | 33,2 |
| All day | ||||
| Sugar | 40 | - | - | 39,8 |
| Butter | 40 | 0,24 | 33,0 | 0,36 |
| Protein-free starch bread | 150 | 1,24 | 3,7 | 71,62 |
| Total | 39,9 | 82,4 | 483 |
Daily set of products included in diets 7a and 7b (gross)
| Product Name | Product weight, g | |
| diet No. 7a | diet number 7b | |
| Protein-free bread, white or bran (achloride) | 100 | 150 |
| Meat | 62 | 125 |
| Eggs | 13 (1/4 pcs.) | 48 (1 piece) |
| Milk | 30 | 80 |
| Sour cream | 30 | 45 |
| Butter | 90 | 80 |
| Vegetable oil | 7 | 20 |
| Sugar | 80 | 110 |
| Sago | 55 | 70 |
| Potato | 235 | 335 |
| White cabbage | 150 | 225 |
| Carrot | 70 | 80 |
| Beet | 130 | 200 |
| Bulb onions | 30 | 40 |
| Green onion | 15 | 15 |
| Greenery | 10 | 20 |
| Green pea | - | 20 |
| Radish | 20 | 35 |
| Fresh cucumbers | 20 | 40 |
| Parsley | 7 | 7 |
| Tomato | 7 | 15 |
| Flour | 18 | 28 |
| Corn starch | 70 | 80 |
Fats all kinds, with the exception of refractory ones (lamb, pork and beef).
Sweet dishes, sweets, fruits, berries. Jelly, puree-mousse prepared with swelling starch, sugar, honey, jam, sweets. Any fruits, berries, raw or boiled. Fruit juices. Pumpkin, watermelon, melon are recommended.
In table An approximate one-day menu for diet No. 7a is given.
Diet No. 7b
Indications for prescribing the diet, intended purpose, general characteristics of the diet, culinary processing are the same as for diet No. 7a.Proteins 40 g (of which 25-30 g are animals), fats 80-90 g (of which 60-65 g are animals), carbohydrates 450 g. Calories 2800 kcal. Table salt 2-3 g (in products). Vitamin content: retinol -0.95 mg, carotene -5.5 mg, thiamine -0.7 mg, riboflavin -
1.1 mg, nicotinic acid -7.5 mg, ascorbic acid - 282.7 mg. Mineral content: calcium - 460 mg, potassium - 2650 mg, phosphorus - 690 mg, iron - 19.3 mg, magnesium - 200 mg. The total amount of free liquid is 1-1.5 liters. The weight of the daily ration is 2.5 kg. The temperature is normal. The number of meals is 5-6 times a day.
In table A one-day diet menu No. 7b is given.
In table The daily set of products included in diet No. 7 a and 7 b is given.
Dietary treatment with a sharp restriction of protein in the diet requires a sufficient caloric content of the diet (2200-2800 kcal) and a maximum reduction in vegetable proteins in it. At the Institute of Nutrition of the Academy of Medical Sciences, a team of employees of the technology department under the leadership of G. S. Korobkina developed protein-free products from cereal starch and swelling amylopectin starch. These products include protein-free bread, confectionery (cakes, cookies), pasta, noodles, vermicelli, cereals (such as semolina, rice, etc.), fruit mousses, jellies, creams. Artificial sago made from corn starch is widely used as a cereal substitute.
Chemical composition and calorie content of special dietary products and dishes recommended for use in low-protein diets
The chemical composition of some protein-free foods and dishes is presented in table.Name of dishes | Output, g | Proteins, g | Fats, g | Carbohydrates, g | Calories, kcal |
| Protein-free bread from corn starch | 100 | 0,83 | 2,5 | 47,8 | 280 |
| Potato soup with sago | 300 | 1.47 | 3,9 | 19,9 | 124 |
| Sago cutlets | 140 | 0,4 | 7.9 | 49,4 | 288 |
| Sago cabbage rolls | 250 | 5.2 | 11.0 | 30,2 | 252 |
| Potato zrazy, stuffed sago with onions | 200 | 5,6 | 12,2 | 55,9 | 381 |
| Sago porridge, crumbly oil, water | 200 | 0,5 | 11,8 | 66,0 | 383 |
| Sago porridge with milk | 150 | 1,58 | 3,8 | 25,3 | 151 |
| Sago pudding with apples | 200 | 3,2 | 6,3 | 48,0 | 276 |
| Sago casserole with dried apricots | 200 | 4,33 | 12,1 | 75,1 | 450 |
| Sago and apple casserole | 260 | 3,7 | 12,0 | 65,3 | 407 |
| carrots Sago pilaf with fruits | 180 | 0,94 | 11,8 | 81,5 | 463 |
| Cherry puree-mousse with swelling starch | 140 | 0,78 | - | 20,2 | 207 |
| Plum shore mousse with swelling starch | 140 | 0,38 | - | 53,3 | 220 |
Therapeutic nutrition for end-stage renal failure
Currently, the treatment of patients with end-stage renal failure (ESRD) is based on the use of chronic hemodialysis in combination with dietary therapy. When using hemodialysis, patients may develop some complications due to nutritional imbalance. Due to the fact that in patients with terminal uremia the metabolism of proteins and amino acids in the body is disrupted, the leading direction in building a dietary regimen is to determine the adequate amount of protein in the diet and its qualitative composition. Hemodialysis treatment, along with the washout of toxic substances, is accompanied by a loss of amino acids, which leads to significant changes and restructuring of the amino acid spectrum of blood serum. Depending on the duration of the procedure, a different percentage of decrease in the total concentration of amino acids in the blood serum is noted: with 6-hour hemodialysis, the level of amino acid nitrogen decreases by 16-20% of the original, with 9-10 hours - by 20-30%. During hemodialysis, valine, threonine, isoleucine, arginine and histidine are subject to the greatest leaching from essential amino acids; of the replaceable ones - series, citrulline, alanine, ornithine. Under the influence of hemodialysis, the content of strait, cystine, glycine and aspartic acid is normalized in patients. The concentration of methionine and tryptophan decreases. The "artificial kidney" filters everything that passes through the burrows of the artificial membrane. Replenishment of amino acids lost in the dialysate solution should be ensured by a rationally expanded diet.The diet should be salt-free (hyponodium). All food is prepared without salt. If the patient does not have high blood pressure, edema, or heart failure, 2-3 g of salt are given to him.
Due to the risk of developing hyperkalemia in a patient with ESRD, it is recommended to limit the amount of potassium administered with food to 2500 mg per day. Limit the amount of phosphorus introduced with non-protein foods (legumes, red cabbage, mushrooms, etc.), as well as dairy products containing a significant percentage of calcium and phosphorus, since the increased content of these minerals contributes to the development of renal osteodystrophy.
The diet of patients with ESRD undergoing regular hemodialysis should contain 0.75-1 g of protein per 1 kg of body weight per day. The amount of protein in the diet also depends on the number of hemodialysis sessions per week: when increasing the hemodialysis time to 30 hours per week, it is necessary to increase the protein quota to 1.2 g/kg. The amount of vitamins in the diet must correspond to their physiological norm; the content of ascorbic acid must be increased to 250 mg per day. For patients with ESRD, diet No. 7g is recommended.
Chemical composition and calorie content of diet No. 7g. Protein 60 g (of which 3/< животного происхождения), жиров 110 г, углеводов 450 г. Калорийность 3000 ккал.
Vitamin content: retinol - 1.55 mg, carotype - 4.96 mg, thiamine - 1.34 mg, riboflavin - 2.5 mg, nicotinic acid - 13.44 mg, ascorbic acid - 250 mg. Mineral content: potassium - 2542.5 mg, calcium - 624.5 mg, magnesium - 301.6 mg, phosphorus - 1192.7 mg, iron - 22.3 mg. Daily diet contains 45 g of animal protein, which is introduced in the form of meat, eggs and fish, provides the body with an optimal amount of essential amino acids. The caloric content of the diet is provided by fats and carbohydrates.
Much attention should be paid to the taste of the diet. A variety of products are recommended, fresh vegetables and fruits, melons (cucumbers, tomatoes, new potatoes, apples, plums, watermelon, etc.), adding spices, sour vegetable and fruit juices (lemon, plum, apple, cherry, tomato, etc. ). However, due to the possibility of developing hyperkalemia, strict control over the amount of fruits and fresh vegetables consumed is necessary, and some of them are prohibited (apricots, bananas, dried fruits, legumes, etc.).
The amount of free fluid is limited to 700-800 ml, with anuria to 300-400 ml.
The daily set of products included in diet No. 7g is presented in table.
Table 78
Daily set of products included in diet No. 7g (gross)
Product name | Product weight, g | Product name | Product weight, g |
| White bread salt-free | 100 | Flour | 10 |
| Tomatoes | 45 | ||
| Salt-free black bread | 100 | Fresh cucumbers | 40 |
| Green pea | 35 | ||
| Meat or fish | 100 | Apples | 250 |
| Egg | 120 (2.5 pcs.) | Cabbage | 160 |
| Carrot | 40 | ||
| Milk | 140 | Beet | 50 |
| Sour cream | 140 | Bulb onions | 8 |
| Cottage cheese | 25 | Tomato paste | 10 |
| Butter | 40 | Green onion | 10 |
| Vegetable oil | 35 | Greenery | 15 |
| Sugar | 60 | Parsley | 5 |
| Potato | 300 | Honey | 50 |
Culinary processing. All dishes are prepared without salt. Meat and fish are given boiled or followed by frying, which reduces the amount of extractive substances.
Flour dishes and cereal dishes are limited due to their high vegetable protein content.
Meals are fractional (6 times a day).
List of recommended foods and dishes for patients with terminal uremia undergoing hemodialysis.
Salt-free white and black bread (200 g per day).
Soups. Vegetarian with various vegetables, borscht, beetroot soup, cabbage soup made from fresh vegetables with herbs and roots (250 ml) without salt, fruit soups.
Meat and poultry dishes. Low-fat varieties of beef, veal, chicken, turkey, rabbit, tongue, boiled or subsequently baked and fried. Meat, minced or in pieces (55 g per day).
Fish dishes. Different types of fish instead of meat, boiled or then fried.
Vegetable dishes and side dishes. Potatoes, white cabbage, cauliflower, lettuce, tomatoes, fresh cucumbers, beets, greens. Vegetables boiled or then fried. Allowed in kind.
Dishes and side dishes from cereals and pasta are limited, are used in the form of pilaf with fruit, casseroles, and boiled as a side dish.
Snacks. Vegetable and fruit salads, vinaigrette without pickles.
Eggs and dishes made from them. Whole soft-boiled eggs, omelettes, for preparing other dishes (2-3 pieces per day).
Dairy products and dishes made from them are limited. It is allowed to roll up to 200 g per day, cottage cheese in the form of pudding or casserole.
Fruits, berries, sweet dishes and sweets. Fruits and berries are best eaten raw, as well as baked or boiled. Sugar, honey, jam.
Beverages. Tea, weak coffee, rosehip infusion, raw fruit juices.
Sauces and spices. Milk sauce, sauce made with sour cream, cream, water. Sweet and sour vegetable and fruit sauces. Horseradish, mustard, pepper, vinegar, cinnamon, cloves in limited quantities.
Fats. Butter and vegetable oil. Refractory fats are excluded.
Limited to: scooping currants, cherries, melons, peaches, pineapples, rhubarb, raisins, currants, figs, prunes, red cabbage, celery, mushrooms, chicory.
Prohibited: spicy, salty dishes. Meat and fish broths, mushroom broths. Canned snacks, sausages, smoked meats, chocolate. Dried fruits, apricots, legumes,
Approximate one-day diet menu No. 7g (2950 kcal)
Name of dishes | Output, g | Proteins, g | Fats, g | Carbohydrates, g |
| First breakfast | ||||
| Soft-boiled egg (2 pcs.) | 96 | 10,2 | 10,9 | 0,5 |
| Vegetable Salad | 150 | 4,0 | 11,4 | 18,0 |
| Kissel | 200 | 0,2 | - | 46,1 |
| Lunch | ||||
| Baked apple | 120 | 0,4 | - | 29,3 |
| Dinner | ||||
| Vegetarian borscht with sour cream (1/3 portion) | 250 | 2,15 | 6,76 | 12,69 |
| Boiled meat | 55 | 16,0 | 3,2 | - |
| Fruit jelly (lemon) | 125 | 2,9 | - | 20,0 |
| Afternoon snack | ||||
| Fruit mousse with swelling starch | 140 | 0,4 | - | 53,3 |
| Dinner | ||||
Potato zrazy with | 160 | 6,3 | 14,5 | 43,0 |
| Sour cream | 100 | 2,1 | 28,2 | 3,1 |
| Kissel | 200 | 0,2 | - | 46,1 |
| For the night | ||||
| Rose hip decoction | 200 | - | - | - |
| All day | ||||
| White achloride bread | 150 | 12,4 | 1,2 | 78,8 |
| Sugar | 40 | - | - | 39,8 |
| Butter | 20 | 0,12 | 16,5 | 0,18 |
| Honey or jam | 50 | 0,2 | - | 38,85 |
| Total | 61,0 | 101,6 | 451,8 |
Methodology for differentiated use of dietary nutrition in patients with chronic renal failure and end-stage renal failure. The prescription of low-protein diets for patients with chronic renal failure and the duration of their use are determined by the degree of renal failure. With glomerular filtration above 40 ml/min, significant protein restrictions are usually not required, since these patients tolerate quite significant protein loads quite well - 60-80 g of protein (1 g/kg body weight). When glomerular filtration decreases to 30 ml/min, it is necessary to limit protein in the diet to 40 g (i.e. 0.5 g/kg), which gives a completely satisfactory therapeutic effect. It should be borne in mind that 30 g of protein in the diet should be of animal origin (egg whites, cottage cheese, boiled meat). Vegetable proteins (bread, potatoes and other vegetables, cereals, fruits) should be only 10 g. In case of significant proteinuria, the content protein in food increases according to this loss (for every 6 g of urine protein, one chicken egg).
A diet containing 30 g of animal protein can be used in any hospital. On an outpatient basis, patients with chronic renal failure can slightly expand their dietary regimen, increasing the proportion of protein to 60 g, while using regular foods.
When glomerular filtration in patients with chronic renal failure decreases to 15 ml/min, the protein content in the diet is reduced to 20 g per day (0.25-0.3 g/kg) (diet No. 7a), and all this amount should be animal protein. Quite satisfactory treatment results can be obtained from the use of this diet with a filtration rate of about 10-5 ml/min. Only when glomerular filtration is less than 4-3 ml/min is it necessary to transfer patients to hemodialysis with appropriate dietary recommendations.
The main therapeutic diet for most patients with chronic renal failure is diet No. 7b, containing 40 g of protein. This diet is well tolerated by patients and can be used for a long time both in a hospital and on an outpatient basis.
The disappearance of uremic symptoms and a decrease in the level of nitrogenous waste in the blood occurs faster when using diet No. 7a, containing 20 g of protein, than diet No. 7b. The content of urea and residual nitrogen in the blood serum also decreases faster when prescribing diet No. 7a. However, in patients receiving this diet, as dyspeptic disorders disappear, the feeling of hunger gradually increases and weight loss is noted. Therefore, diet No. 7a cannot provide a positive nitrogen balance with prolonged use.
The most adequate diet for long-term use in kidney patients is diet No. 7b. Only in case of advanced renal failure, treatment should begin with diet No. 7a, and then, as the patients’ condition improves, transfer them to diet No. 7b, against the background of which diet No. 7a can be periodically applied in the form of “zigzags”. The duration of diet No. 7a is determined individually, but it is used for no more than 25 days.
When transferring a patient with terminal uremia to hemodialysis, he is prescribed diet No. 7g.
List of products recommended for transfer from home to patients with chronic renal failure. Fruit juices: orange, grape, cherry, pomegranate, tangerine, peach, plum, cherry, apple and others at the rate of 400 g per day.
Fruits and melons: quinces, pineapples, oranges, pears, grapes, cherries, strawberries, strawberries, raspberries, lemons, tangerines, peaches, plums, red and black currants, cherries, apples, as well as watermelon and melon at the rate of 100-120 g of fruits and 300-350 g of melons per day.
List of products recommended for transfer from home to patients with end-stage renal failure on regular hemodialysis. Fruit juices: apple, plum, cherry, black cherry, tomato, carrot at the rate of 150-200 g per day.
Fruits and melons: apples, plums, lemons, cherries, pears - 120 g; watermelon, melon at the rate of up to 300 g per day.
Vegetables: tomatoes, cucumbers, etc. up to 200 g per day.
The intake of fruit juices, fruits and vegetables must be alternated.
Nutritional therapy for nephrotic syndrome
Nephrotic syndrome is kidney damage with massive proteinuria, hypo- and dysproteipemia, widespread edema, hypercholesterolemia and other disorders. In approximately 76% of patients, the cause of nephrotic syndrome is glomerulonephritis; in other cases - amyloidosis, diabetic nephropathy, nephropathy of pregnancy, circulatory failure, etc.Dietary therapy is based on the characteristics of the pathogenetic mechanisms of the disease. Against the background of the use of corticosteroid drugs, cytostatics and immunosuppressants, to compensate for the significant loss of protein, diet No. 7c is prescribed with a high protein content, a sharp limitation of table salt (sodium ions), liquid enriched with lipotropic factors (methionine, phosphatides), while fully providing the body with vitamins and minerals substances and microelements.
Diet No. 7c
Indications for use. Various chronic kidney diseases, amyloidosis, tuberculosis, rheumatism and collagenosis, accompanied by nephrotic syndrome.Special purpose. Replenishment of protein loss, reduction of hypoproteinemia, dysproteinemia and hypercholesterolemia, reduction of domestic syndrome and proteinuria.
General characteristics of the diet. Sharp limitation of table salt (only 2-3 g contained in products), extractives, liquids (up to 800 ml of free liquid), increase in protein content (1.6 g/kg), mainly due to egg, milk and fish protein, full provision of the body's needs with minerals, vitamins and microelements, exclusion from the diet of substances, drinks and foods that irritate the kidneys (alcohol, nitrogenous extractives, cocoa, chocolate, spicy, salty snacks), inclusion of vegetable oils in the diet (1/3 of the total amount of fat), methionine and phosphatides, which have a lipotropic effect.
Chemical composition and calorie content of the diet. Proteins 125 g (of which 80 g are animal), fats 80 g (of which 25 g are of plant origin), carbohydrates 450 g (refined 50 g), table salt 2-3 g (in products). Calorie content 2900 kcal.
Vitamin content: retinol - 0.95 mg, carotene - 11.7 mg, thiamine - 0.7 mg, riboflavia - 1.1 mg, nicotinic acid - 17.5 mg, ascorbic acid - 100 mg. Mineral content: potassium - 3000 mg, calcium - 600 mg, magnesium - 285 mg, phosphorus - 1220 mg, iron - 21 mg.
Free liquid 800 ml. Diet weight 2.5 kg. The food temperature is normal, the number of meals is 5-6 times a day.
An approximate one-day menu for diet No. 7c is presented in table.
List of recommended products and dishes.
Bread and bakery products. Bran bread, wheat, white, salt-free.
Vegetarian soups with cereals, vegetables, fruits are prepared without salt.
Meat and poultry dishes. Low-fat varieties of beef, pork, lamb, chicken, turkey, rabbit, boiled or subsequently fried, in pieces or chopped.
Fish dishes. Low-fat fish (pike perch, perch, roach, pike, navaga, cod) boiled, chopped or in pieces.
Dishes and side dishes from cereals and pasta. Semolina, rice, wheat, buckwheat, pearl barley, etc. porridges with water, milk, crumbly; Krupeniki, puddings, zrazy, pilaf, cutlets.
Vegetable dishes and side dishes. Potatoes, carrots, beets, pumpkin, zucchini, cauliflower, tomatoes, cucumbers, lettuce, parsley. Boiled, baked, pureed, pureed.
Egg dishes. Bolkovy smelt and for preparing various dishes (more than 2 pieces per day).
Milk and dairy products and dishes made from them. Whole milk, kefir, yogurt, cottage cheese (low-fat) in its natural form, curd pudding, lazy dumplings.
Sauces and spices. White sauce, tomato sauce, marinade sauce, vegetable sauce. Sweet and sour vegetable and fruit sauces with the exception of meat, fish and mushroom broths. Prepared with water, milk, sour cream, cream.
Beverages. The tea is not strong. Raw fruit and vegetable juices. Rose hip decoction.
Fats. All kinds, with the exception of refractory ones (lamb, beef, pork).
Approximate one-day menu of diet No. 7b (2674 kcal)
Name of dishes | Output, g | Proteins, g | Fats, g | Carbohydrates, g |
| First breakfast | ||||
| Steamed omelette stuffed with meat | 150 | 18,2 | 13,6 | 3,1 |
| Krill paste marinated (without salt) | 180 | 11,0 | 17,6 | 13,8 |
| Tea with milk | 200 | 1,4 | 1,7 | 2,25 |
| Lunch | ||||
| Prunes | 50 | 0,9 | - | 32,8 |
| Dinner | ||||
Vegetarian pearl barley soup with vegetables | 250 | 1,5 | 2,4 | 13,4 |
Meat balls baked in sour cream | 110 | 20,9 | 14,9 | 16,8 |
| Stewed carrots with prunes | 190 | 3,3 | 13,5 | 38,6 |
| Fresh apples | 100 | 0,3 | - | 11,5 |
| Afternoon snack | ||||
| Rose hip decoction | 100 | - | - | - |
| Dinner | ||||
| Stuffed fish | 85/150 | 17,3 | 10,1 | 7,0 |
| Steam pudding from low-fat cottage cheese | 150 | 16,9 | 6,7 | 34,3 |
| Tea without milk | 100 | |||
| For the night | ||||
| Kefir | 200 | 5,6 | 7,0 | 9,0 |
| All day | ||||
| White bread | 100 | 7,9 | 1,9 | 52,7 |
| Bran bread | 150 | 14,7 | 7,2 | 54,5 |
| Sugar | 30 | - | - | 29,9 |
| Total | 120,0 | 96,8 | 319,4 |
Sweet dishes, sweets, fruits, berries, melons and vegetables. Any fruits and berries without limitation, raw or boiled. Watermelon, melon, pumpkin. Sugar is limited to 50 g (you can use honey instead - 70 g).
Excluded: turnip, radish, sorrel, spinach, garlic.
Therapeutic nutrition for phosphaturia
Phosphaturia is characterized by a violation of the acid-base balance towards alkalosis and the precipitation of poorly soluble calcium phosphate in the urinary tract. The development of phosphaturia is associated with a violation of the ratio of calcium and phosphorus in the urine as a result of an increase in the excretion of calcium in the urine and the loss of acidic valencies by the body. At the same time, with phosphaturia there is a complex chain of neurohumoral-renal disorders.Sodium and potassium phosphates are soluble in urine, which is both acidic and alkaline; Calcium and magnesium phosphates are insoluble in alkaline urine.
Treatment for phosphaturia is aimed mainly at acidifying the urine and limiting foods rich in calcium. It is necessary to exclude from the diet spicy snacks, spices, alcohol that excite the nervous system, and substances that are an active stimulant of the secretory function of the stomach if phosphaturia is accompanied by gastric hypersecretion.
They recommend a diet with a limitation of dairy and vegetable foods and a predominance of meat foods, flour dishes, with a sufficient content of vitamins (A and D) and plenty of fluids. The diet can include weak tea without milk or weak coffee with a small amount of cream, bread, eggs and egg dishes in limited quantities, butter and vegetable oil, meat, fish soups, meat or fish in all types, flour dishes in all types ( with excess body weight are limited). Fish (non-spicy) snacks, not very salted herring, and canned fish in small quantities are allowed. Of greens and vegetables, you can only include in your diet those varieties that are low in calcium and alkaline valencies (peas, Brussels sprouts, asparagus, pumpkin). Berries and fruits are limited (lingonberries, red currants, sour apples are recommended); pastry products are allowed in small quantities.
Long-term restriction of calcium compounds in the diet negatively affects metabolism, therefore, against the background of the main “zigzag” diet, you can periodically include foods containing calcium (vegetables, fruits, herbs) in the diet.
Therapeutic nutrition for oxaluria
Oxaluria is the persistent excretion of calcium oxalate crystals in the urine. The disease is associated with a violation of the kidneys' secretion of protective coddoids, which maintain normal oxalic acid in a dissolved state. Calcium onsalates fall out at any urine pH, most often at 5.4-6.6.When creating a diet for patients with oxaluria, it should be taken into account that the introduction of foods rich in oxalic acid with food increases the excretion of oxalates in the urine. Products with an excess content of oxalic acid and its salt are excluded from the diet: sorrel, spinach, beets, potatoes, beans, rhubarb, figs, parsley, some berries (plums, strawberries, gooseberries), tea, cocoa, coffee, chocolate. The source of oxalic acid formation can be gelatin due to its 16-19% glycol content.
Apples, pears, quince, pear tree leaves, grapes, black currants (in the form of a decoction) help remove oxalates from the body. Decoctions prepared on fruit peels increase the release of oxalic acid from the body.
The diet of a patient with oxaluria includes the following products: white and black bread, animal and vegetable butter, milk, cottage cheese, sour cream, eggs, sour dairy products, cheese, vegetarian soups (from permitted vegetables and fruits), milk soups, meat, fish and poultry boiled in limited quantities (150 g every other day), cereal and dough dishes, cauliflower and white cabbage, lentils, peas, green peas, turnips, asparagus, cucumbers, apples, pears, apricots, peaches, grapes, dogwoods, quince.
A patient with oxaluria is allowed to administer a sufficient amount of liquid (up to 2 liters) and juices of fresh vegetables and fruits. Table salt and carbohydrates are somewhat limited in the diet. For patients with oxaluria, diet No. 5 can be recommended with a restriction of carbohydrates to 300 g. During the period of exacerbation of the disease, it is necessary to limit the inclusion in the diet of milk and dairy products containing a significant amount of calcium.
Unlike many other treatment tables, the diet for kidney failure is characterized by a very high-calorie diet. Why is that? The fact is that if a sufficient amount of calories does not enter the body with food, it will begin to use internal resources - proteins, which, breaking down, will increase the urea content in the blood. The patient will begin to weaken and lose weight. And only a high-calorie menu will avoid this negative process - urea nitrogen will be used to form new protein molecules, and its content in the blood will not increase.
I would like to immediately note that the diet for chronic renal failure should be used only by people suffering from this particular disease - treatment tables No. 7a and 7b in no case apply to any other kidney diseases (pyelonephritis, kidney stones, etc.).
This disease is caused by irreversible damage to the kidneys, during which the processes of removing metabolic products from them such as uric acid, urea, and creatinine are disrupted. Against this background, the water and electrolyte balance in the body is seriously disturbed. Therefore, the basics of rational nutrition involve reducing consumption:
- salt (no more than 1-2 g per day, and ideally switch to)
- excess protein (no more than 20-70 g of protein per day, with preference given to vegetable protein)
- potassium
- liquids (no more than 1 liter per day)
At the same time, the diet for renal failure should include:
- fractional 5-6 meals a day
- Increased energy value of food (up to 2700-3000 kcal per day) due to increased consumption of carbohydrates and fats
- sufficient content of vegetables and fruits in the daily menu (taking into account their content of proteins, salts and vitamins)
- special culinary processing, which is designed to improve appetite - baking, boiling followed by frying, adding seasonings, spices, and spices to dishes. A diet for acute renal failure involves avoiding raw fruits and vegetables - cooking compotes, soups, etc. will reduce the potassium content in products almost widow's
Nutrition for chronic renal failure: list of prohibited foods
- Drinks: alcohol, strong coffee, cocoa, tea, hot chocolate.
- Salty snacks.
- Refractory fats (beef, pork, lamb) and broths based on them.
- Mushrooms and mushroom broth.
- Sorrel, spinach, cauliflower and other foods rich in purine and oxalic acid.
- Legumes, pasta, cereals.
- Sausages, smoked meats, canned products.
- Bananas, apricots, dried apricots, prunes, raisins.
- Irritant seasonings: mustard, horseradish.
- Garlic, radish, radish, turnip.
Diet for chronic renal failure: allowed foods
- Starch cereals (sago) and dishes made from it, rice.
- Bran, salt-free, protein-free bread (in particular from corn flour).
- Vegetarian and fruit soups.
- Meat: lean beef, veal, rabbit, chicken, turkey.
- Fish: lean (roach, pike, pike perch, perch, navaga).
- Vegetables: potatoes, beets, carrots, tomatoes, pumpkin, green onions, parsley, dill.
- Eggs: egg white omelette (but no more than 1 egg per day).
- Dairy products: milk, cream, sour cream, kefir, yogurt, acidophilus (all in limited quantities)
- Drinks: diluted juices from fruits and vegetables, weak tea, rose hip decoction.
- Jelly, mousses and other dishes from fruits, berries in starch, honey, sugar, jam, jam. Melon and watermelon are especially useful.
- Candies, sweets.
- Spices: allspice, black pepper, bay leaf, cloves, cinnamon, vanillin.
This is what a diet for kidney failure looks like. Before planning a menu, be sure to visit your doctor - he will conduct the appropriate research and be able to more accurately suggest what calorie intake you should focus on, depending on the stage and nature of the disease.
