1. Renal failure

It is considered that a renal failure exists when the renal functionalism is inferior to 50%. The transplanted kidney has a limited life of about 12 years. This is the main reason to avoid certain lifestyles and assume a specific Acute Renal Failure Diet.

1.1. Functions of the kidney

  • Homeostasis: water, electrolytes, acid-basic balance
  • Purification of the nitrogen remainders
  • Endocrine function (mechanism renine-angiotensin to regulate the arterial tension)
  • The kidney synthesizes the eritropoyetine. Because of renal disease, anemia tends to appear.
  • Synthesis of active vitamin metabolites D. Because of renal disease the absorption of calcium falls
  • Formation of the urine.

It is important to have a good understanding of the kidney’s functions, mostly because the success of the Acute Renal Failure Diet depends on this.

2. Acute renal failure

The acute renal failure (definition): it is a syndrome of variable etiology

  • dehydration
  • great burnings
  • tumors that compresses urethra
  • sepsis
  • hemorrhages

All these symptoms are potentially reversible. They are characterized by a deterioration of the renal function that causes hyperazoemia (accumulation of nitrogen remainders). This happens in a progressive way, with alterations of the hydro-electrical and acid-basic balance and -in many cases- oliguria (a diuresis in proportions inferior to 400 ml/day).

2.1. Dietetic objectives in the dietetic treatment of the acute renal insufficiency

The objectives of the acute renal failure diet are to maintain the chemical composition of the organism more close possible to normality, and to preserve the organic deposits of proteins until the renal function returns to the proper levels.

The dietetic intervention important must, coverall to the catabolic state of some patients. The objectives are:

  • To diminish the metabolic disorder
  • To reduce catabolism

2.2. Dietetic strategy in the acute renal failure

The acute renal failure diet pretends to assure a nutritional contribution suitable to:

  • Renal function: according to oliguria
  • Duration of the disease
  • Diuresis: in order to adapt the contribution of liquids
  • Catabolism degree
  • Nutritional state
  • Treatment: if there is a dialysis or not… In case of dialysis, the diet can be lifted in proteins (in patients in a situation of important catabolism)

A proper route of suitable administration is something to look for.

2.3. Nourishing recommendations in the acute renal failure

  • Energy: 35-50 Kcal/ideal weight/day

If the elevated protein catabolism is not producing enough energy… it makes worse the renal failure, due to an increase of uric acid and the creatinine (it does not increase the urea)

  • Proteins:
    • Treatment without dialysis: 0.25-0.5 g/kg/day of which 20-30 g of proteins of high biological value/day Treatment with dialysis: 1-1,2 g/kg/day
  • Liquids:
    • Oligúrica phase: according to the losses. Diuresis + 500 ml insensible losses + other losses (vomits, diarrhea, fistules, drainages, great fevers)
    • Diuretic phase: voluntarily

The weight can be an indicator of the increase or diminution of liquid

  • Sodium:
    • Oliguric phase: 20-40 mmol/day. 1 mol (23 mgs) corresponds to 1 Eq
    • Diuretic phase: voluntarily
  • Potassium: the risk of hyperpotasemia exists. This can lead to death to produce upheavals of the heart rate.

Mmol K (39 mgs) 1 will require 25-40 mmol being 1 mEq K

Phosphorus: medication to increase the excretion to avoid a deficiency disease.

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