Patients, middle-aged women, 45 years old, teacher.
Complained of fatigue, back pain, edema of lower extremities for more than 2 years, and increase the difficulty in walking for 1 months.
The history of January 2007, general fatigue, back pain, lower extremity edema, patients with cold cough, since Chinese medicine, no symptoms, not after treatment. More than 1 months ago, there was no obvious cause of walking difficulties, lower extremity edema significantly increased, there is a sense of heaviness. Biochemical examination showed that 12.56 mmol/L urea, creatinine 385 u mol/L; peripheral blood red blood cell count of 2.39 x 1012/L, hemoglobin 70 g/L. Diagnosis of acute renal damage, no significant improvement after treatment, biochemical creatinine 485.8 mmol/L, was admitted to the hospital for further diagnosis and treatment. Mental illness, poor sleep, poor appetite.
A history of hypertension 4 years, drug therapy can control blood pressure. Six months before cholecystectomy, denied the history of allergies, denied hepatitis, tuberculosis and other infectious diseases.
Clinical diagnosis of chronic renal failure (CRF), renal dysfunction: renal anemia.
Nutritional status evaluation
Height of 1.55 m patients, weight of 55 kg. The incidence of the past 1 months, the daily intake of staple food of about 150 ~ g, about G meat, vegetables and fruits of 300 ~ 400 g, no intake of milk, eggs and their products. Admission biochemical examination showed albumin 3l.5 g/L, urea 22.25 umol/L, creatinine 545.8mmol/L, cholesterol of 2.49 mmol/L. The nutritional evaluation was conducted by using subjective comprehensive nutritional assessment (sGA).
Principles of nutritional therapy
Low protein diet (LPD) low protein diet can reduce the amount of protein in the urine, reduce the burden of protein and amino acid metabolism, delay renal failure, delay dialysis time.
There is no uniform standard for protein intake, but the commonly used method is based on glomerular filtration rate to give the corresponding amount of protein: the compensatory stage of renal insufficiency: the recommended amount of protein can be used in normal diet, 1 g/ (kg day); the renal insufficiency decompensation and renal failure time: low protein diet (LPD), a protein of 0.5 ~ 0.6g/ (kg day); uremia; very low protein diet (VLPD), a protein of 0.3 ~ 0.4g/ (kg day).
In the case of protein restriction, to ensure the quality of protein >50%, mainly for animal protein, which contains a high proportion of essential amino acids, the body's absorption and utilization rate higher than the plant protein.
Adequate supply of adequate energy is an important condition for the success of a low protein diet. The body can increase the breakdown of carbohydrates, fat, reduce protein degradation to low protein diet, if enough calories, fat, protein, glycogen mobilization consumption, will lead to malnutrition, plasma albumin, urine protein, urea nitrogen can not improve. CRF patients were calculated for their gender, age, body mass index (BIM), disease stress, activity level. Generally 25 ~ 40 kcal/ (kg - day), overweight and low activity of people with low energy, lean and high energy consumption, to maintain positive nitrogen balance.
Due to the regulation of the kidney, reabsorption, secretion and metabolism, CRF patients in the body of water and electrolyte metabolism disorder, mainly in the sodium, potassium, calcium, phosphorus. In order to alleviate the symptoms of edema and hypertension, CRF patients to encourage the use of low salt diet, no edema and hypertension patients can be 4 to 6 g/ days, patients with edema and hypertension should limit the intake of salt, from 2 to 3 g/.
The application of essential amino acids and a- acid a- acid containing no nitrogen when a- acid into L- amino acids corresponding, the synthesis of amino acid metabolism of the nitrogen, saves the nitrogen source, can also lower blood urea nitrogen and creatinine, can also add EAA in the blood, improve the rate of protein synthesis, improve nitrogen balance. Correction of malnutrition. Clinical transformation by ketoacids supplement essential amino acids, improve the metabolism of protein, with enough heat to correct malnutrition, improve the symptoms of uremia, protecting residual renal function.
The main source of vitamins and minerals in sufficient amounts of vitamins and trace elements. Vegetables and fruits are rich in vitamins, plant fiber, pectin, trace elements, etc., should be guaranteed at least 400 ~ 500 g intake per day. If the food source is insufficient, can give vitamin, mineral supplements.
Beijing In China