The kidney is an important organ of the human body, which maintains water, electrolyte and acid-base balance by producing and excreting urine, excreting waste products produced by metabolism in the body; regulating blood pressure, calcium and phosphorus metabolism and stimulating bone marrow hematopoiesis by secreting bioactive substances such as renin, prostaglandin, 1,25-dihydroxyvitamin D3 and erythropoietin. In order to delay the progress of kidney disease and improve the quality of life, you should pay attention to the following points in your daily life.
1.Scientific intake of diet and nutrition
(1) Those with simple hematuria (either ocular or microscopic hematuria) and/or mild proteinuria (<1g/d) can enter the general diet.
(2) Acute nephritis: those with edema or hypertension in the acute phase should have a low-salt (<3g/d) diet. Those with normal renal function do not need to restrict protein intake; in case of azotemia, protein intake should be restricted, with high-quality animal protein (such as milk, eggs, fish, lean meat) as the mainstay. Patients with acute renal failure who are obviously oliguric need to limit fluid intake (to the extent of thirst) and potassium intake in food. Fresh fruits such as bananas, oranges, grapefruit, vegetables such as tomatoes, potatoes, mushrooms, etc. contain high potassium, and the soup can be poured off fruits, meat and vegetables after cooking to remove potassium salts. Normal diet can be resumed after 2-3 months of disease stability.
(3) Chronic nephritis: the acute attack of chronic nephritis may appear as carnal hematuria, edema, hypertension and even uremia, which requires the dietary principles of acute nephritis. The remission period can be a normal diet.
(4) Nephrotic syndrome: high quality protein diet 0.8~1.0g/(kg.d) and adequate calories, not less than 126~147kJ/kg (30~35kcal/kg) per day, low salt (<3g/d) diet in case of edema. Eat less diet rich in saturated fatty acids (animal fats) and more diet rich in polyunsaturated fatty acids (such as vegetable oil and fish oil) and soluble fiber (such as oats, rice bran and beans).
(5) uric acid nephropathy: drink more water, more than 1500ml per day, to maintain adequate urine output, limit high purine foods (such as animal offal, fish, shrimp, sea crab and other seafood, meat, soy products, yeast, etc.), strictly prohibit alcohol consumption, and reduce dietary energy.
(6) Diabetic nephropathy: control the diet according to the requirements of diabetes, protein intake 0.8 g/(kg.d) for those with normal renal function, and for those with elevated blood urea nitrogen, it should be limited to 0.6 g/(kg.d). At least 1/3 from animal protein.
(7) Chronic renal failure: diet requires “three high and three low”, i.e. high calorie (>35kcal/kg per day): calorie source is mainly provided by sugar and vegetable fats, if you feel hungry, you can eat sweet potato, taro, potato, apple, lotus root powder, etc. High B-vitamins. High trace elements (zinc, selenium, etc.): lean meat, aquatic products, animal offal, nuts, legumes, coarse grains, etc. High quality low protein: 0.8 g/(kg.d) for GFR 60~89 ml/min; 0.6 g/(kg.d) for GFR 30~59 ml/min; 0.4 g/(kg.d) for GFR 15~29 ml/min. To limit the intake of vegetable protein, wheat starch (wheat flour is added with water and made into dough, then kneaded repeatedly with water, and its slurry is precipitated to obtain wheat starch) can be used as staple food instead of rice and flour. To avoid malnutrition, it can be supplemented with essential amino acids or their a-keto acids (such as Kai Tong). Low phosphorus (<600 mg/d): Refined cheese, skimmed milk powder, dried fish, seaweed, animal offal, etc. contain high phosphorus, which can be chewed and swallowed with food at mealtime as a phosphorus binding agent (e.g. calcium carbonate). Low fat. Others: Except for edema, hypertension and oliguria who should limit salt, it is generally not advisable to strictly limit salt. When the daily urine volume exceeds 1000ml, there is generally no need to restrict potassium in the diet. Those with urine volume >1000ml and no edema should not restrict water intake.
(8) Maintenance dialysis: high quality protein diet, protein intake is 1.2 g/kg.d for maintenance hemodialysis patients and 1.2-1.3 g/(kg.d) for maintenance peritoneal dialysis patients, phosphorus intake <600 mg/d. Water restriction: generally it is appropriate to control weight gain of 0.5 kg per day, sodium restriction: sodium should be limited to 2-3 g per day, potassium intake should be restricted and supplemented with Various vitamins, folic acid and iron.
2.Stable control of blood pressure
Persistent hypertension will accelerate the deterioration of renal function, so blood pressure must be reduced to the target value: urine protein <1g/d, blood pressure £130/80 mmHg; urine protein >1g/d, blood pressure £125/75 mmHg.
(1) Lifestyle changes: low-salt diet, restricted alcohol consumption, increased exercise and weight loss.
(2) Drug therapy: The commonly used antihypertensive drugs can be divided into the following five categories.
a. Diuretics: including potassium-depleting diuretics such as dihydrocoumaric acid (prohibited in patients with gout) and tachyphylaxis; potassium-preserving diuretics such as anisodone, which are not easily combined with ACEI and are prohibited in renal insufficiency.
b. Angiotensin-converting enzyme inhibitors (ACEI): such as Lortin, the onset of antihypertensive effect is slow, reaching the maximum effect in 3-4 weeks. It may cause irritating dry cough, which may disappear after discontinuation. It is prohibited in hyperkalemia, pregnancy and bilateral renal artery stenosis.
c. Angiotensin II receptor blockers (ARB): such as Coxswain, the onset of antihypertensive effect is slow, but long-lasting and smooth, reaching the maximum effect only in 6-8 weeks, does not cause dry cough, contraindications are the same as ACEI.
d, calcium channel blockers (CCB): including short-acting agents such as nifedipine and long-acting agents such as Boydin (felodipine extended-release tablets) and Loxodipine (amlodipine).
e. Beta-blockers (e.g., betalactam) or beta-blockers with a-blocking effects (e.g., Almare): use with caution in patients with diabetes mellitus and contraindicated in patients with bronchial asthma and atrioventricular block.
Others: a-blockers (e.g. prazosin), central a-blockers (e.g. colistin), etc., are not used as first-line antihypertensive drugs.
Patients with renal disease mostly require combination medication. Please choose individualized treatment regimen and monitor blood pressure under the guidance of your doctor, and do not stop treatment or change treatment regimen frequently. When there is a sharp rise in blood pressure with headache, jet vomiting, chest pain, sudden oliguria and other symptoms promptly seek medical attention!
3.Don’t abuse drugs
Certain drugs have toxic effects on the kidneys and should be avoided by patients with kidney disease, especially those with chronic renal failure. These include aminoglycoside antibiotics, antipyretic and analgesic drugs such as anti-inflammatory pain and aminopyrine, chemotherapy drugs such as cisplatin and 5-fluorouracil, various contrast agents, and Chinese medicines with ingredients such as mucuna pruriens. Inform your doctor of your kidney history during your visit.
4. Avoid straining, prevent infections such as colds and diarrhea, and face life with an optimistic attitude
Note: High quality protein means that its essential amino acid content and ratio are closer to human protein, which can be fully utilized by the body and produce less metabolic waste. The best of them are milk and eggs, followed by fish and lean meat, and again soybeans and their products. Cereal proteins are inferior proteins, such as steamed buns and rice.