Managing Kidney Health: Diet and Function in Patients

Q: Managing Kidney Health: Diet and Function in Patients

Hello： 1. <br>Frequent urination (is it the frequency or the volume?) and nocturia are not necessarily indicative of kidney problems; it is advisable to consult a urologist to examine the bladder. <br>2. <br>There is currently insufficient evidence to determine the effectiveness

Kidney disease management

Hello Dr.
Yang,
I have a smaller left kidney (congenital, not due to atrophy) and during winter, I experience high blood pressure, increased urination, and nocturia.
After visiting the hospital for follow-up examinations, my kidney function has remained within a reasonable range, and my blood pressure has normalized with medication.
However, I have been strictly controlling my diet (the doctor only advised to eat less meat and salt).
I have reduced my protein intake to about 0.8 grams per kilogram, which may be insufficient in terms of caloric intake.
As a result, I am losing weight, and my creatinine levels have decreased from 1.1 to around 0.83.
Does this indicate improper dietary habits or that my kidney function is still deteriorating but not yet reflected in the tests? How can I remedy this situation? I would appreciate a detailed explanation.
Thank you very much.

(For the past four years, due to polyuria and nocturia, I have been experiencing unexplained discomfort and have visited several hospitals for examinations.
My data, including urine protein, anemia, electrolyte levels, and BUN, have all remained within normal ranges, with a clearance rate above 80.)

Nanping, 50~59 year old female. Ask Date: 2010/03/24

Dr. Yang Zhongwei reply Internal Medicine

Hello: 1.
Frequent urination (is it the frequency or the volume?) and nocturia are not necessarily indicative of kidney problems; it is advisable to consult a urologist to examine the bladder.
2.
There is currently insufficient evidence to determine the effectiveness of a low-protein diet in the absence of proteinuria.
3.
Serum creatinine is produced from muscle metabolism; if your serum creatinine level has decreased due to weight loss and reduced muscle mass, you should reconsider! Please calculate your BMI to see if it falls within the normal range; if it is on the lower side, it is recommended that you gain some weight.
4.
Blood pressure control is absolutely essential! The higher the blood pressure, the greater the strain on the kidneys, increasing the likelihood of future damage.

Reply Date: 2010/03/24

More Info

Managing kidney health is crucial, especially for patients with existing kidney conditions or those who have undergone anatomical changes, such as having a smaller kidney. It’s commendable that you are actively monitoring your health and seeking to understand the implications of your dietary choices on your kidney function.

From your description, it appears that you have been proactive in managing your blood pressure and have been vigilant about your diet. However, the concern about your weight loss and muscle mass reduction is significant. A protein intake of around 0.8 grams per kilogram of body weight is typically considered adequate for the general population, but for individuals with kidney issues, especially those who are not on dialysis, the protein requirements can vary based on the stage of kidney disease and overall health status.

Understanding Kidney Function and Diet
1. Kidney Function: Your creatinine levels have improved from 1.1 to 0.83, which is a positive sign indicating that your kidney function is stable or improving. The glomerular filtration rate (GFR) is a critical measure of kidney function, and maintaining it above 80 mL/min is generally considered good. However, fluctuations in kidney function can occur, and it’s essential to monitor these levels regularly.

2. Dietary Protein: While reducing protein intake can be beneficial in certain stages of kidney disease, it’s essential to ensure that you are not under-consuming protein to the point where it affects your muscle mass and overall health. If you are experiencing significant weight loss and muscle wasting, it may be necessary to reassess your protein intake. High-quality protein sources, such as lean meats, fish, eggs, and dairy, can provide the necessary nutrients without overwhelming the kidneys.

3. Caloric Intake: If you are reducing protein, you must ensure that your overall caloric intake is sufficient to meet your energy needs. A diet too low in calories can lead to muscle breakdown as the body seeks energy from muscle tissue. This can exacerbate feelings of fatigue and weakness. Consider consulting with a registered dietitian who specializes in renal nutrition to create a balanced meal plan that meets your specific needs.

4. Sodium and Fluid Intake: You mentioned that your doctor advised reducing salt intake. This is crucial for managing blood pressure and preventing fluid retention. However, if you are experiencing increased urination, it’s essential to balance your fluid intake to avoid dehydration. Monitoring your fluid intake and output can help you maintain optimal hydration levels.

5. Monitoring Symptoms: The symptoms you describe, such as increased urination and feelings of malaise, could be related to various factors, including dietary imbalances, medication side effects, or even anxiety about your health. Keeping a symptom diary can help you and your healthcare provider identify patterns and potential triggers.

Recommendations for Improvement
- Consult a Dietitian: A renal dietitian can help you tailor your diet to ensure you are getting adequate protein and calories while managing your kidney health. They can provide personalized advice based on your specific health status and dietary preferences.

- Regular Monitoring: Continue to monitor your kidney function through regular blood tests and check-ins with your healthcare provider. This will help you catch any changes early and adjust your management plan accordingly.

- Physical Activity: Engage in light to moderate physical activity as tolerated. Exercise can help maintain muscle mass and improve overall well-being. Always consult your healthcare provider before starting any new exercise regimen.

- Medication Review: Ensure that your blood pressure medications are appropriate and effective. Sometimes, side effects from medications can contribute to symptoms like fatigue or increased urination.

In conclusion, while it’s essential to be cautious with your diet, it’s equally important to ensure that you are meeting your nutritional needs to maintain your health. A collaborative approach involving your healthcare team, including your physician and a dietitian, will be beneficial in managing your kidney health effectively.

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