Which kidney disease patients need protein dietary restrictions, how to limit it? 1, nephrotic syndrome NS patients have a large amount of protein loss, a large amount of proteinuria can add to the original pathology of the kidney that aggravates, but also can cause hypoproteinemia resulting in protein malnutrition. However, we do not advocate a high protein diet for NS patients (to prevent increasing glomerular filtration rate and accelerating glomerulosclerosis), NS patients should eat an easily digestible, light, high quality protein (animal protein rich in essential amino acids) diet and ensure a daily caloric supply of at least 30-35kcal/kg. However, in case of severe NS (e.g. hemoglobin), the daily protein intake should be 1g/kg. However, in case of severe NS (e.g. blood albumin <20g/L, urine protein >10g/L), a short-term high-protein diet [1,0-1,3g/kg, d] can be considered. For patients with chronic renal insufficiency (azotemia), a low-protein diet [0,6-0,8g/kg,d] should be considered, along with the addition of α-keto acids or essential amino acids, which can both delay the progression of renal failure and avoid the occurrence of malnutrition. In addition, for patients who apply hormone therapy, the protein requirement should be about 100g per day because hormone can accelerate protein decomposition. 2, chronic renal failure Although long-term chronic kidney disease progresses to the stage of chronic renal failure, the body protein reserves decline, but a large number of studies found that: low protein diet can reduce the symptoms of uremia, and can slow down the progress of most patients with chronic renal failure, or even temporarily stop progress for a period of time. Therefore, low-protein diet therapy is an important part of nutritional therapy for patients with chronic renal failure. Protein intake in patients with chronic renal failure should be individualized according to the patient’s underlying physical fitness and condition. For non-dialysis patients with chronic renal insufficiency, the basic principle of low-protein diet is to appropriately reduce protein intake to maintain the body’s nitrogen balance needs. When the GFR is 10-20 ml/min, 0.6 g/kg/day should be used while maintaining high calories, and 5 g can be added when it is greater than 20 ml/min. It is generally believed that when the GFR drops below 50 ml/min, protein restriction is required, of which about 50-60% must be proteins rich in essential amino acids (i.e. high quality protein with high biomass value, such as eggs, fish, lean meat, milk, etc.). lean meat, milk, etc.). Since patients with chronic renal failure also have disorders of amino acid metabolism, the addition of essential amino acids to a low-protein diet can not only correct the disorders of amino acid metabolism, but also improve the nutritional status of protein, which is better than low-protein diet treatment alone. For dialysis patients, the DOQI guideline guidelines call for a protein diet of 1,2-1,3 g/kg, d. We call for 0,9-1,1 g/kg, d protein in peritoneal dialysis patients with peritonitis or inflammatory protein malnutrition may also be increased. Energy is maintained at 30-35kcal/kg, d,, obese, diabetic and elderly patients, etc. slightly reduced, wasting, and slightly increased in younger patients. 3, acute renal failure Acute renal failure patients are often accompanied by a state of high protein catabolism. Nutrition during the oliguric phase of acute renal failure is very important and should be given enough calories as much as possible to ensure the metabolic needs of the body and to prevent further breakdown of their own proteins. In order to reduce the source of nitrogen and potassium, protein is prohibited during the first 48-72 hours of the oliguric phase, and later a low-protein diet of 0,3-0,5g/kg per day is given, and high-quality protein is used. If the patient is on dialysis, protein may not be strictly limited, but may be given 1g/kg, d or slightly more. During the polyuric period, protein intake still needs to be appropriately restricted, and it can generally be relaxed only when the blood creatinine and urea nitrogen levels drop to normal. In addition, it has been reported that low protein diet in diabetic patients can reduce intra-glomerular hypertension and hyperfiltration without altering blood glucose and blood pressure, and slow down the deterioration of renal function. After determining the protein and calorie intake, the patient should contact a dietitian to help him/her choose high quality protein to provide sufficient amount of essential amino acids, such as eggs, dairy, and lean meat, fish and poultry. In principle, more animal protein should be consumed, but foods with high purine and nucleoprotein content, such as liver, kidney, heart and fish eggs, should be prohibited because they can be converted into uric acid and increase the burden on the kidneys. Plant proteins with high content of non-essential amino acids, such as corn and flour, should be avoided as much as possible, and wheat starch can be used as part of the patient’s staple food.