Glomerulonephritis - Clinical Symptoms And Dietary Modification

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 infections.

Clinical Symptoms

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.

Dietary Management

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.

Energy

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.

Protein

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.

Sodium

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.

1.     Salt during cooking and on the table.

2.     Baking powder and soda bicarbonate - added to cakes and biscuits.

3.     Sodium benzoate added to soft drinks and canned foods.

4.     Papads, cheese, nuts, popcorn, biscuits, salted chips

5.     Bacon, Ham, Meat extracts, commercial sauces, soup cubes.

6.     Monosodium Glutamate - Ajinomoto used in Chinese fried rice and Briyanis.

7.     Proprietary drinks - Bournvita, Chocolate drinks

8.     Dried fruits and Dried fish.

Food with Moderate sodium should be taken in restricted amounts.

1.     Milk and Curds

2.     Pulses and legumes - all varieties

3.     Vegetables - radish, Carrot, Broad beans, cauliflower, field beans, knol khol, green mango, Beet root, Amaranth, parupukeerai, spinach, karamani

4.     Miscellaneous foods which include

Coriander seeds, cumin seeds, Turmeric, Jaggery.

Potassium

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 also dangerous.

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.

Free Foods

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.