With renal insufficiency (kidney weakness, kidney failure), the kidneys function only to a limited extent or not at all. A progressive decline of nephrons (work units of the kidneys) leads to irreversible (irreversible) damage and thus loss of function of the kidneys. The main job of the kidneys is to filter & purify the blood to detoxify the body.

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Typical symptoms of end-stage kidney weakness (terminal kidney failure) are:

• Nausea, vomiting & loss of appetite

• Drowsiness, drowsiness

• High blood pressure (no longer adjustable) & an irregular heartbeat

• The amount of urine decreases

• Water retention (edema)

• Shortness of breath

• Convulsions, coma

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Healthy kidneys have a glomerular filtration rate (GFR) of 95-110 ml per minute. This results in about 180 liters of blood that our kidneys filter every day. The more the  Renal insufficiency worsens, so this value also worsens (becomes smaller and smaller).

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Why is nutritional therapy important?

Nutritional therapy supports you in optimally supporting your kidneys in their function and in optimally supplying your body with all of the fatty acids, micronutrients (vitamins and minerals), energy and protein that are important to you. Depending on the stage of your illness (1-5), different nutritional therapeutic measures are necessary for a sufficient supply of your body (e.g. energy, protein, electrolytes such as potassium). Overall, the therapy aims to avoid foods that promote inflammation and at the same time consume plenty of anti-inflammatory foods. Weight reduction may be advisable if you are overweight / obese. Patients with kidney disease should discuss with their doctor whether they need to control their fluid intake.

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Chronic renal failure

Staging: 1 - 5 according to the GFR or according to retention values (laboratory values: urinary substances increase)

Classification according to GFR (source: National Kidney Foundation, Kidney Disease Outcome Quality Initiative, KDOQI)

Renal insufficiency - stage 1

GFR> 90 milliliters / min. (= Kidney disease with normal GFR)

Further information: Mostly incidental finding, possibly edema present, or discolored urine, the creatinine level in the blood is still normal, but often there is already an increased amount of protein in the urine (= signs of a disorder of kidney function). The first pathological changes in the kidneys may be visible in the ultrasound.

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Renal insufficiency - stage 2: mild functional impairment

GFR 60-89 milliliters / min.

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Renal insufficiency - stage 3: Moderate functional impairment

Division into 2 stages: GFR 45 - 59 milliliters / min. & GFR 30 - 44 milliliters / min.

Further information: The filter function of the kidneys is so reduced that the creatinine blood values and urea are increased. At this point at the latest, symptoms such as high blood pressure , loss of performance and lack of strength occur. Now the risk of cardiovascular diseases is increased. There is often a loss of appetite , unwanted weight loss (risk of malnutrition ), anemia, first disturbances in the water and electrolyte balance.

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Renal insufficiency - stage 4 - severe functional impairment - renal replacement therapy is required

GFR 15-29 milliliters / min.

Further information: complaints such as Loss of appetite , nausea, vomiting, tiredness, itching, nerve and bone pain, edema formation (e.g. on legs and face).

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Renal Failure - Stage 5 - Terminal Renal Failure  - End-stage kidney weakness

Kidney replacement therapy is essential

GFR <15 milliliters / min.

Further information: uremia symptoms, transition to coma uraemicum.

The patient is dependent on blood washing (hemodialysis, HD), abdominal washing (peritoneal dialysis, PD) or a kidney transplant.

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Functions of the kidneys:

• Detoxification: urinary substances (creatinine, urea, uric acid), foreign substances, medication, environmental toxins

• Keeping the water balance and osmotic pressure constant through electrolyte regulation

• Hormone production: renin & erythropoietin, vitamin D activation in calcitriol

• Maintenance of the acid-base balance: blood pH value: 7.4, supports the bicarbonate buffer (HCO3- + H + <-> H2CO3 <-> CO2 + H2O), H + excretion - regulation

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Urination

• Renin controls the filtration pressure

• Filtration / d = 180 liters = 1.5 liters of urine / day

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Kidney threshold of glucose: 180mg / dl / day

= max.absorption amount! -> more glucose is excreted as remainder (in diabetes mellitus)

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Nephron (renal cortex) = functional unit

Nephrons consist of kidney corpuscles & tubules

1) Kidney corpuscles - primary urine formation 

• Glomerulus-vessel unit (arteries) -> ultrafiltration

• Baumann capsule (close-meshed filter, proteins get stuck)

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2) renal tubules (tubular apparatus)

• - reabsorption, secretion, concentration

• Secondary urine formation (terminal urine)

• proximal tubule (reabsorption: AS, glucose, water, electrolytes)

• Henle loop (water)

• distal tubule (water, electrolytes)

• Connecting tubules (electrolytes)

Collection pipe (water reabsorption point) collects the secondary urine & guides it into the renal pelvis

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Kidney replacement procedure:

• Requirement: semipermeable membrane!

• Semipermealbel (dialysis machine or peritoneum)

• Hemodialysis (washing blood outside the body)

• Peritoneal dialysis (CAPD), detoxification via the peritoneum

• Kidney transplant

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Classification of your weight - definition and classification of weight in relation to height.

Special percentile curves apply to children and adolescents; the BMI cannot simply be used here.

BMI and interpretation: BMI: body mass index. Formula: Body weight in kg : (body height in m) 2

Underweight: <18.5

Normal weight: 18.5 - 24.9

Overweight = pre-obesity: 25-29.9

Obesity grade I: 30 - 34.9

Obesity grade II: 35-39.9

Obesity grade III:> 40 = per magna

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Nutritional therapy

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• Anti-inflammatory nutrition as a basis, individually tailored to you

• Individual energy & protein requirement calculation & electrolyte supply

• Holistic therapy - do you have any comorbidities that need to be taken into account during the consultation?

• Overall fat selection, how should it be designed

• How many animal foods (e.g. meat products, milk and dairy products, cheese, fish products, eggs) are recommended?

• What do I have to look out for when choosing animal foods?

• How can I counteract inflammatory processes through diet?

• Body weight: If you are overweight / obese, weight reduction may be recommended.

• Avoid micronutrient deficiencies and mineral deficiencies & possibly counteract them with nutrient preparations

• Prevent protein deficiency / excess protein

• Which nutrients do I need in which ratio?

• Get enough fiber (> 30 g / day) through natural foods, possibly fiber substitution

• Sufficient fluid: total fluid per day: 30 - 35 ml per kg body weight and day. Attention, this is not just a drinking liquid. The liquid from food (approx. 500 - 800 ml) must still be subtracted from this, so that an amount of approx. 1.3 - 2 l of drinking liquid is created. In consultation with your doctor, a fluid limit may be necessary, this will then be taken into account.

• add valuable anti-carcinogenic (anti-cancer) secondary plant substances

• A selection of foods tailored to your needs with cooking and technical information (for breakfast, snacks, lunch, dinner)

• Do you like to eat your warm meal in the evening? I am happy to cater to your individual situation and we will create a plan on how you can implement your wholesome diet into your everyday life.

• which oils are good for me? What should I watch out for in relation to the anti-inflammatory diet?

• How much fat spread (butter / margarine / vegetable fat) can I use and which products are recommended?

• Get enough Omgea-3 fatty acids and essential fatty acids

• How can I boost and support my metabolism with natural foods?

• Coordinate sensible meal frequency for your individual case - meal allocation

• Define the desired weight stabilization / normalization & the estimated period for this

• what should be considered with beverages and alcoholic beverages?

• How does exercise affect your body and thus also your diet?

• Avoid blood sugar fluctuations

• Sweetening foods - sweeteners, glucose, fructose, sugar and sugar substitutes, what can I use and in what quantities? How high is the respective sweetness of the different products?

• what should be considered when baking and cooking?

• what are cheap snacks / main meals

• Eating out - what should you watch out for?

• Vacation, boat trip or hospital stay, what should be considered?

• Flatulence, bloating, diarrhea, constipation, vomiting, heartburn, loss of appetite, pain related to eating, what can I do about it?

• Daily plans as an example for practical implementation in everyday life

• Enjoyment training

• Optimizing your eating situation

• long-term maintenance of a jointly defined weight

• Strengthen the stomach and intestines with natural foods

• Additional therapy options

• Dietetic products in support of nutritional therapy

• Food supplements - under certain circumstances, a supplement can be useful

• and other topics

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Any questions? I look forward to your call or email. To contact form

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Assistance:

• KISS self-help groups

• Self-help network

• German Kidney Foundation

• German Society for Nephrology

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