GLOMERULONEPHRITIS - CLINICAL SYMPTOMS AND DIETARY MODIFICATION
Glomerulonephritis is an inflammatory process
affecting the glomeruli, the small blood vessels in the head of the nephron. It
occurs mostly in children and young adults. The most common cause is a previous
streptococcal infection such as tonsillitis, pneumonia and respiratory
In some patients there is swelling of the ankles and puffiness around
the eyes. Some complain of headache, anorexia, nausea and vomiting.
Hypertension and dimness of vision may occur. Classic symptoms include
haematuria, proteinuria, oedema and shortness of breath as a result of sodium
and water retention can occur. Tachycardia and elevated blood pressure may be
present. The patient is generally anorexic which contributes to feeding
problems. If the disease progress, oliguria or anuria occurs which signals the
development of acute renal failure.
During the acute phase of illness when nausea and vomiting are present,
effort should be made to maintain fluid balance and to provide non-protein
calories to minimize the catabolism of tissue proteins.
Salt is restricted if there is oedema, hypertension or oliguria. Bed
rest and antibiotic therapy are the main treatment.
As the patient improves and appetite returns the following dietary
modifications are done.
The recommended dietary allowances provide a general guide for the
calorie requirements for the particular age and weight and 10% percent more for
infection. For children 80 kcal / kg body weight is suggested. Sufficient
calories is given without increasing the protein intake. High carbohydrate, low
electrolyte supplements like fruit juices sweetened with glucose, honey, sago
and cereals are given.
If the blood urea nitrogen is elevated and oliguria is present dietary
protein is restricted. For older children the diet contains 0.5 g of protein /
kg of ideal body weight and 1 to 1.5g / kg per day for younger children. A low
protein diet is given to give rest to the kidneys. If anuria develops, proteins
should be stopped. An intake of 20-40 g / day is sufficient, out of which 50
percent should be from animal protein. Pulses and groundnuts increase urea
levels in the blood and should be restricted.
If there is oedema or hypertension, sodium
restriction to 500 or 1000 mg may be prescribed. In sodium restricted diets,
the following foods are avoided.
Salt during cooking and on the table.
Baking powder and soda bicarbonate - added to
cakes and biscuits.
Sodium benzoate added to soft drinks and canned
Papads, cheese, nuts, popcorn, biscuits, salted
Bacon, Ham, Meat extracts, commercial sauces,
Monosodium Glutamate - Ajinomoto used in Chinese
fried rice and Briyanis.
Proprietary drinks - Bournvita, Chocolate drinks
Dried fruits and Dried fish.
Food with Moderate sodium should be taken in restricted amounts.
Milk and Curds
Pulses and legumes - all varieties
Vegetables - radish, Carrot, Broad beans,
cauliflower, field beans, knol khol, green mango, Beet root, Amaranth,
parupukeerai, spinach, karamani
Miscellaneous foods which include
seeds, cumin seeds, Turmeric, Jaggery.
When the kidneys don't function properly, potassium builds up in the
body and causes the heart to beat unevenly and stop. Too little potassium is
All fruits and vegetables contain potassium. Apple, Guava, Papapa, pear
and pine apple have the lowest amount of potassium and may be used once or
twice a week.
Nuts, Jaggery, tender coconut water, instant coffee, chocolate and coco
powder are very high in potassium content and should be avoided.
Potassium content can be reduced in vegetables by 'leaching'
- cooking in excess water and then discarding the water. All spices and
condiments contain potassium and should be used only in small quantities.
When proteins, sodium and potassium are restricted it is difficult to
obtain sufficient energy. Foods low in protein, sodium & potassium but
provide energy can be given. These include sugar, lollipop, sago, boiled
sweets, sugar candy unsalted butter, unsalted margarine, dalda, oil and ghee.