Renal nephropathy treatment. Useful products for nephropathy

Diabetes causes dangerous complications. In diabetes, various groups of human organs are affected, including kidney function may be impaired.

This, in turn, leads to serious health consequences, and if left untreated, even to the death of the patient.

A diet for diabetes and kidney problems, combined with the right medication, can help solve the problem.

But why does high sugar levels negatively affect kidney function? The kidneys in diabetes are negatively affected by several important factors.

First of all, an excess of glucose in the blood has a negative effect.

It combines with tissue proteins - glycation occurs, which impairs kidney function. Glycated proteins cause the body to produce special antibodies, the action of which also negatively affects the kidneys.

In addition, in the blood of diabetics, there is often an excess content of platelets, which clog small vessels. And finally, the poor absorption of water into the cells and the insufficiency of its removal from the body increase the amount of blood that the kidneys must purify by passing through themselves.

All this leads to the fact that glomerular hyperfiltration occurs - the acceleration of the work of the renal glomeruli. And ultra-high loads negatively affect the performance of the organ and lead to damage to the glomerular apparatus - diabetic nephropathy. It is characterized by a significant decrease in the number of active glomeruli due to blockage of intraglomerular capillaries.

When the number of affected glomeruli reaches a certain point, symptoms appear that indicate the development of renal failure:

• headache;
• nausea and vomiting;
• digestive disorders;
• severe shortness of breath;
• metallic taste and bad breath;
• itching on the skin;
• convulsions and spasms.

With the further development of the disease, more serious consequences are possible - fainting and even coma. Therefore, it is very important to start treatment as early as possible, while the kidneys are still doing their job of cleaning the blood.

Treatment of diabetic nephropathy

Treatment of nephropathy begins with the control of sugar levels. After all, it is significant excess sugar levels that are the cause of the development of kidney damage in diabetes.

The next necessary condition for the successful fight against the disease is to reduce the level of blood pressure.

It is necessary that the pressure normalizes at the level of 130/80, and it is better to be even lower.

Finally, nutrition plays a very important role in kidney failure, in diabetes mellitus. After all, compliance with certain nutritional rules allows you to reduce the concentration of sugar in the blood and reduce the load on the kidneys, thus preventing the defeat of new capillaries.

The diet must be agreed with the attending physician.

Diet principles

The basic principle that the diet for diabetic nephropathy should follow is to prevent an increase in sugar levels and reduce the load on the kidneys. Dietary recommendations vary considerably at different stages of the disease.

So, at the first, easy stage, it is very important to control the content of not only sugar in food, but also protein. These measures are necessary to facilitate the work of the kidneys.

A low-protein diet significantly reduces the burden on the kidneys and helps to cope with the disease. In addition, an important factor in the disease is also. In this regard, it is recommended to limit the consumption of salts as much as possible.

If at the first stage of the disease in the first place is the control of sugar levels, then with the development of diabetic nephrosis, the most important is the control of animal protein intake. After all, there are special drugs to lower sugar levels, while the effectiveness of drugs that reduce the load on the kidneys is much lower.

The best option would be to almost completely replace animal proteins with vegetable proteins. According to research results, the proportion of animal proteins in the patient's diet should not exceed 12%.

In addition, in addition to limiting the intake of salt, protein and sugar, it is recommended to significantly reduce the amount of foods containing phosphates when the disease develops. Phosphorus also has the ability to affect the kidneys and exacerbate hyperfiltration.

In addition, limiting the intake of animal fats is also shown. After all, they are the source of cholesterol, which forms plaques that narrow blood vessels. At the same time, such a narrowing is typical not only for the vessels of the brain - excess cholesterol also has a significant effect on the capillaries in the kidneys, being an additional risk factor for their blockage.

What products are prohibited?

There is a fairly wide range of food products, which, if a diet for kidney failure in diabetes mellitus is followed, are not only not recommended - it is directly prohibited.

First of all, sugar and products containing it, or a large amount of fructose, including honey, fruit molasses, etc., should not be consumed. Such products should be completely excluded.

In addition, you can not eat any pastries made from white flour. These products contain a lot of fast carbohydrates. Limit the consumption of fruits with too much fructose - bananas, dates,. Do not eat also sweet varieties of pears, apples, watermelon.

You should not eat fried foods, fatty meats. Banned pork, lamb, fatty fish. It is also not recommended to eat high-fat dairy products - fatty cottage cheese, sour cream, etc.

In addition, you can not eat pickles and smoked meats - they also always have a lot of salt, which increases blood pressure.

Butter and margarine, which contain a huge amount of animal fats, are excluded. Undesirable and use.

It is forbidden to drink carbonated drinks, especially sweetened ones, as well as fruit juices, even natural freshly squeezed ones - their intake can provoke an increase in glucose levels.

Under the ban, of course, any dose of alcoholic beverages, as well as spicy seasonings and spices. Tea should be used with caution, and it is better to completely refuse coffee.

The diet can cause problems with stools, which are solved by taking gentle natural remedies.

What needs to be consumed?

The main part of the diet should be vegetables. They should be consumed raw, steamed, stewed, boiled - just not fried.

There are no restrictions on vegetables, with the exception of potatoes. It is recommended to use it in baked form, no more than 200 grams per day.

The most useful cereal, which must be introduced into the diet for diabetic nephropathy, should be recognized. It contains practically no simple carbohydrates that are contraindicated for diabetics. Other cereals, especially semolina, should be used with caution.

It is very useful to eat greens in general and green vegetables in particular. Animal fats are best obtained from dairy products, controlling their amount.

Of the juices, it is recommended to use mixtures of tomato juice with other vegetable juices.

From fruit juices, it is permissible to take small amounts of fresh plum juice.

In general, nutrition in kidney failure and diabetes, in addition to limiting certain foods, should also be characterized by moderation in portions. In no case should you overeat - this negatively affects both the balance of enzymes in the body and the condition of the kidneys.

You should not use pearl barley - it contains too many carbohydrates.

Diet for kidney failure and diabetes, menu for the week

The menu examples below are examples for making the right menu for diabetic nephropathy.

They can be alternated, mixed, changed, without forgetting the list of prohibited and undesirable products. Compliance with such a diet will help to cope with kidney damage and improve the general condition of the body and the well-being of the patient.

The first menu option includes a breakfast of a steamed protein omelet, rye bread toast and two tomatoes. If the glucose level is not too high, drinking coffee with a sweetener is acceptable.

Lunch should consist of lean soup and two or three slices of wholemeal bread. For an afternoon snack, you need to eat orange or lemon jelly with a sweetener or milk jelly. For dinner - boiled low-fat chicken, vegetable salad with unsweetened homemade yogurt, unsweetened tea with lemon is possible.

The second version of the dietary table for nephritis caused by diabetes.

For breakfast - fat-free cottage cheese with one toast, a salad of sour berries. For lunch - fish soup with lean fish, baked potatoes, tea.

Snack - green unsweetened apples. For dinner - a salad of fresh cucumber and lettuce, rosehip broth.

The third choice of dishes. For breakfast - buckwheat porridge with skim milk. For lunch - vegetarian soup from fresh cabbage, steamed chicken cutlet, vegetable salad without oil. In the afternoon - protein mousse without sugar. Dinner - seafood salad and unsweetened tea.

Of course, the diet for diabetic kidney nephropathy has a more extended list of foods and dishes.

The selection of dishes can be done by yourself, avoiding forbidden dishes and following the simple rule of combining products.

Meat or fish dishes should not be consumed at the same time with dairy products, even low-fat ones.

The only exception that can be allowed is the addition of natural unsweetened yogurt or low-fat kefir to a vegetable salad.

Do not abuse spices and seasonings, as well as soy products.

Related videos

Diabetic Diet Basics:

Compliance with the diet will help to cope with the disease and lower blood sugar levels, as well as significantly improve the patient's well-being and increase the effectiveness of prescribed medications.

The formation of diabetic nephropathy is accompanied by a violation of the kidneys. The disease develops gradually. In this case, several stages of the disease are distinguished, each of which is characterized by certain symptoms and the degree of damage to the organ. For the treatment and prevention of the disease at each stage, in addition to treatment with medications, you need to adhere to proper nutrition. The diet for diabetic nephropathy directly depends on the stage of the disease. As a rule, one of three types of low-protein diet is used - 7, 7 a, 7 b. Each of the diets is used in the complex treatment of diabetic nephropathy.

Diet 7

In the culinary processing of food, preference is given to baking, boiling and steaming.

This diet for nephropathy allows you to remove nitrogenous metabolic products from the body, helps to reduce pressure and reduce swelling. It is prescribed at an early stage of the disease, and is also used for acute nephritis and is prescribed from 3-4 weeks from the start of treatment. Also, the diet is suitable for chronic nephritis.

This dietary food limits the amount of fats and carbohydrates in the patient's body. For the preparation of dietary food, you should almost completely abandon the use of salt. With the permission of the doctor, you can slightly add salt to the dish before use. The daily amount of liquid is also limited - taking into account liquid dishes, it should not exceed 1 liter.

Important: diet number 7 prohibits the use of essential oils, that is, horseradish, onion and garlic, as well as oxalic acid, fatty meat, fish, mushrooms and extractives.

In the culinary processing of food, preference is given to baking, boiling and steaming. Fried food is contraindicated. It is not necessary to use mechanically gentle food, that is, it does not need to be ground and chopped. Lean meat and fish can be boiled and eat 100-130 g per day. All food must be warm.

The total calorie content of the diet is 2700-2900 kcal:

Carbohydrates - 40-460 g (of which sugar is only 80-90 g).

Proteins - 80 g (only half of them can be of animal origin).

Fats - 90-110 g (a quarter of them should be vegetable).

Salt - no more than 10 g per day.

Liquids (meaning not only water, but also soup, tea) - no more than 1.1 liters.

They eat 4-5 times with equal intervals between meals.

List of allowed products:

• salt-free bread, pancakes, yeast pancakes without salt;
• fruit and vegetarian soups with vegetables and cereals;
• lean veal, boiled tongue, beef, chicken, rabbit, lamb and lean pork tenderloin;
• boiled lean fish (you can bake fish, stuff, pour);
• fermented milk drinks, sour cream, milk, cottage cheese with rice, carrots and apples;
• no more than two eggs per week (it is possible per day, but then you need to reduce the amount of fish, meat and cottage cheese), yolks can be added to dishes;
• rice, corn and pearl barley, sago;
• pasta;
• any vegetables (boiled or steamed, baked);
• vinaigrette without pickles;
• fruit and vegetable salads;
• raw fruits and berries;
• jam, honey, kissels and jelly are allowed by the diet, but diabetic patients can only use special sweets for diabetics.

The following foods should be completely avoided

The following foods should be completely avoided:

• ordinary bread and salty flour products;
• legumes;
• broths on meat, fish or mushrooms;
• smoked products, canned meat, sausages;
• fried foods;
• smoked and salted fish, canned fish, caviar;
• marinades, pickles, pickled vegetables;
• radish, onion, garlic, as well as horseradish, spinach, radish, sorrel;
• chocolate;
• mushrooms.

Diet 7 a

For kidney failure and nephropathy, use this mostly plant-based diet with a drastic reduction in salt and protein

This therapeutic diet is prescribed when the first clinical signs of diabetic nephropathy appear, as well as in acute glomerulonephritis with severe PN. Such a diet for kidney nephropathy is aimed at improving the excretion of metabolic products, reducing edema, reducing the manifestations of arterial hypertension, for a gentle effect on the kidneys.

For kidney failure and nephropathy, this mostly plant-based diet is used with a drastic reduction in salt and protein. The amount of carbohydrates and fats is moderately reduced. Be sure to exclude from the diet food that is rich in essential oils, oxalic acid. At the same time, culinary processing is only baking, boiling and steaming. Products do not need to be crushed. All food is prepared without salt. You can only eat salt-free bread. Six meals a day.

The total calorie content of this diet food is 2150-2200 kcal:

Proteins - 20 g (half of them are proteins of animal origin, and with chronic renal failure - 70%).

Fats - 80 grams (only 15% of them are fats of vegetable origin).

Carbohydrates - 350 g (of which sugar is not more than 80 g).

It is important to completely eliminate salt.

The volume of fluid is determined by the daily amount of urine. It should not exceed it by more than 0.5 liters.

List of allowed foodstuffs:

• protein-free and salt-free bread (based on corn starch) no more than 100 grams or salt-free wheat bread no more than 50 g / d, other yeast flour products without salt;
• vegetarian soups (they can be seasoned with sour cream, herbs and boiled fried onions);
• lean rabbit meat, chicken, veal, beef, turkey - no more than 50-60 grams per day;
• lean fish - no more than 50 g / d (can be boiled, baked or steamed);
• cream, sour cream and milk - no more than 60 grams (more if you reduce the amount of daily protein due to fish and meat);
• cottage cheese is possible if meat and fish are completely excluded;
• ¼ or ½ eggs per day as a supplement or 2 eggs per week;
• cereals - sago is allowed, rice should be limited. They are cooked in water or milk as porridge, pilaf, casserole, pudding or meatballs;
• protein-free pasta;
• fresh vegetables - about 400-500 g per day;
• potatoes no more than 200-250 g / d;
• you can eat parsley and dill, as well as fried boiled onions (added to dishes);
• fruits, berries, compotes, various jelly and fruit jelly;
• honey, jam (for diabetics only special diabetic sweets);
• you can use sweet and sour sauces to improve the taste (sour cream and tomato);
• cinnamon, citric acid, vanillin, fruit and vegetable sauces are allowed;
• it is allowed to drink weak tea with a slice of lemon, diluted juices and rosehip decoctions;
• from fats you can eat butter (unsalted) and vegetable oil.

Among the forbidden foods are broths on meat, fish and mushrooms.

Prohibited foods include the following:

• all flour and bakery products with salt;
• legumes;
• milk and cereal soups (except sago);
• broths on meat, fish and mushrooms;
• fatty varieties of fish and meat;
• smoked meats, canned food, pickles and marinades;
• hard cheese;
• pasta (with the exception of protein-free ones);
• all cereals except sago and rice;
• pickled, salted and pickled vegetables;
• sorrel, spinach, mushrooms, radish, cauliflower, garlic;
• milk jelly, chocolate, ice cream;
• meat, fish and mushroom sauces;
• horseradish, pepper, and mustard;
• natural coffee, mineral water with an abundance of sodium, cocoa;
• animal fats.

Diet 7 b

This diet can be used in the third stage of diabetic nephropathy, with acute glomerular nephritis

This diet can be used in the third stage of diabetic nephropathy, with acute glomerular nephritis, as well as with severe renal failure. Sometimes it is prescribed for chronic nephritis after a diet of 7 a with moderate PI.

The purpose of this diet is the same as that of the first two - the removal of metabolic products from the body, the reduction of edema and arterial hypertension. This diet food severely limits the amount of salt and protein. At the same time, the amount of carbohydrates and fats remains within the normal range. Since the energy value of food cannot fall below the norm, its lack due to a decrease in protein is supplemented with fats and sweets that are allowed for diabetics.

Caloric content of diet food is approximately 2500-2600 kcal:

Protein - 40-50 g (most of them are of animal origin).

Fats - 83-95 g (a quarter of them are of plant origin).

Carbohydrates - 400-460 g of which approximately 100 g of sugar.

Salt is completely excluded.

Liquid no more than 1.2 liters with constant control of diuresis.

Diet depending on the stage of the disease

Daily protein limits depend on the severity of CRF

At the initial stage, you can stick to the usual diet, but with slight restrictions for preventive purposes. You can follow diet number 7.

At the stage of proteinuria, you need to switch to a moderately low-protein diet (diet 7a). The daily protein intake is 0.75-08 g per kilogram of the patient's weight. That is, for men, this is approximately 55 g, and for women - 40-45 g. Half of the daily protein should be of animal origin.

At the third stage, you need to adhere to the following principles of therapeutic nutrition:

Restrictions on daily protein depend on the severity of CRF. This will reduce azotemia and increased filtration through the kidneys of protein metabolites.

The energy value of the diet should be adjusted according to the energy consumption of the body and increase its shortage due to fats and carbohydrates. This will improve the absorption of protein from food and reduce the breakdown of protein from body stores.

It is important to regulate the amount of fluid and salt, taking into account the excretory activity of the kidneys. With the appearance of edema and arterial hypertension, you need to drastically reduce the amount of salt and fluid.

Nephropathy - this term unites all diseases of the kidneys, including pathological diseases. Diseases lead to damage to the kidneys and a decrease in their functions.

Read also our special article nutrition for the kidneys.

There are such types of nephropathy:

diabetic; in pregnant women; toxic; hereditary; other.

With nephropathy, the renal parenchyma and tubules are affected. Because of this, kidney function is impaired.

Causes of the disease

Based on the fact that nephropathy is the consequences of pathological processes in the body, the reasons are different:

1 complications after taking medications; 2 heavy metal poisoning; 3 violation of metabolic processes; 4 tumors; 5toxic substances and so on.

Symptoms of the disease

Since the disease is formed for a long time, and at first, it does not make itself felt in any way. In the future, the following symptoms begin to appear:

Fast fatiguability; weakness; severe and frequent headaches; constant feeling of thirst; aching dull pain in the lower back; puffiness; high blood pressure; the amount of urine decreases.

Useful products for nephropathy

Since with nephropathy, a patient has a large amount of protein with urine, the diet is aimed at saturating the body with protein.

As a result of the kidneys not functioning well, fluid accumulates in the body. Therefore, dietary nutrition is focused on reducing and completely eliminating puffiness.

The main characteristics of nutrition in case of illness:

1 increase the amount of foods containing protein; 2 reduce the consumption of fat-containing foods (about 40% should be vegetable fats); 3enrichment of the body with lipotropic substances that contribute to the normalization of lipid metabolism in the body and lower cholesterol; dietary bread products that do not contain salt; vegetable, vegetarian, dairy, cereal, fruit soups; lean meats: lean veal, beef, lean pork, boiled or baked in one piece; fish - lean varieties, boiled in pieces and chopped, lightly fried after boiling or baked; all dairy products, but with a reduced fat content; cereals - puddings from oatmeal and buckwheat, cereals, cereals; Of the vegetables, the most useful are potatoes, carrots, zucchini, cauliflower, pumpkin, and beets. Green peas are useful in baked, boiled, stewed form; any fruits and berries. Well relieve inflammation of the berries of strawberries, raspberries, lingonberries; from drinks, preference should be given to compotes, fruit juices, herbal decoctions.

Folk remedies for the treatment of nephropathy

There are many folk remedies and fees that relieve inflammation and normalize kidney function.

To collect, you need to take St. John's wort (30 g), coltsfoot (25 g), yarrow flowers (25 g) and nettle (20 g). Everything is crushed and thoroughly mixed. 40 grams of the collection pour ¼ liter of boiling water and let it brew a little. The broth is divided in half and drunk in two doses. You need to drink for 25 days.

Flax seeds, comfrey, bearberry leaves, dyer's gorse. Each herb should be taken in two parts and mixed with blackberry leaves (1 part) and juniper fruits (1 part). Mix everything thoroughly, pour ¼ liter of hot water, boil for 10-15 minutes over low heat. The resulting decoction is taken three times a day.

It is necessary to take one part of cornflower and birch buds, mix with two parts of bearberry, add four parts of a three-leaf watch to them. Pour a spoonful of the collection with boiling water (250 ml) and cook for about 10-12 minutes over low heat. You need to drink a decoction in three doses.

Cowberry berries are very effective in case of disease. Twist the berries and mix with sugar 1:1. The resulting mixture is laid out in jars, tied with paper and put in a cold place. Add berries to taste in water and drink as compote.

Strawberry leaves and berries relieve inflammation well. It is necessary to take berries and strawberry leaves 1: 1, pour the mixture with a glass of water and cook for about 10 minutes. You need to drink 20 g three times a day.

Decoction of watermelon peel

Helps to remove puffiness not only the pulp of watermelon, but also its crusts, which must be brewed.

Dangerous and harmful products for nephropathy

With nephropathy, a large number of products are allowed and the diet is not much different from the diet of a healthy person. But still there are limitations:

Sharp restriction of the amount of salt intake; reduction of products containing extractive substances (these are substances that increase the secretion of digestive juice); restriction of foods containing simple carbohydrates (mainly foods containing glucose); the use of confectionery, sweet flour products, ice cream is limited; all types of canned food, spicy and spicy dishes are excluded from the diet; you can not use pickles, smoked meats, marinades, seasonings.

The term nephropathy combines various pathological processes occurring in the kidneys. Diet for kidney nephropathy is an important component for maintaining health. Such nutrition is aimed at normalizing metabolic processes in the body. In addition to therapeutic nutrition, it is necessary to eliminate the accompanying symptoms, to stop the disease that caused the development of nephropathy.

Reasons for the development of nephropathy

The provocateurs of the problem are:

• diabetes;
• pregnancy;
• gout;
• low hemoglobin;
• heredity;
• poisoning with chemicals or drugs;
• hormonal changes;
• metabolic disorders;
• infectious diseases of the urinary tract;
• stones in the kidneys.

General characteristics of the diet

Thanks to proper nutrition, the urinary system begins to function normally and intoxication of the body passes.

The diet is compiled after a complete examination of the patient in order to determine the individual needs and characteristics of the patient. In the early stages of the disease, it is enough to include small dietary restrictions for prevention purposes. When the form is running, nutrition should be therapeutic. With the help of proper nutrition, the water-salt balance in the body is restored. Thanks to specially selected products, the urinary system begins to function normally, as a result of which the swelling of the extremities decreases or completely disappears. Blood pressure resumes, intoxication of the body passes.

Basic diet rules

• Gradual reduction of animal protein in the daily diet and a gradual transition to vegetable protein.
• Reducing salt intake.
• Restriction of foods high in potassium with an increased concentration of potassium in the blood.
• An increase in foods with a potassium content with a low concentration of potassium in the blood.
• Limit foods high in phosphorus.
• Limiting the consumption of spicy, fatty, canned and pickled foods.
• Transition to fractional nutrition.
• Drinking enough drinking water.
• Taking vitamins, minerals, and iron-rich foods.
• Eating cholesterol-lowering foods.
• Reducing simple carbohydrates in the diet.

More about proteins

Decrease in daily protein intake, an obligatory component of complex treatment of patients.

Damaged kidneys hardly remove nitrogenous wastes, most of all they form proteins of animal origin. However, a sharp rejection of animal products is stressful for the body, which further worsens the state of health. You should gradually reduce your daily protein intake. It is recommended to switch to dietary meat, fish, and then completely to vegetable protein.

More about salt

With the formation of edema, high blood pressure, it is necessary to reduce salt intake. During cooking, do not add salt at all, add a little salt to food before eating. The transition to a salt-free diet occurs gradually to adapt taste sensations. Salt improves the taste of food, so it is important when switching to a salt-free diet to start eating other foods that improve the taste of food: tomato juice or sauce without salt, lemon juice, dried herbs, dried garlic and onions, celery stalk salt.

More about the trace element potassium

Depending on the results of the analysis, it is worth increasing or decreasing the amount of foods containing potassium in the diet. Usually, in the early manifestations of the disease, it is necessary to increase the intake of potassium, and in the later, on the contrary, to limit. Bananas, many nuts, cottage cheese, buckwheat, spinach, avocado, oatmeal are rich in potassium. If there is a need to reduce potassium in the product, heat treatment is used.

About phosphorus and water

A gradual decrease in phosphorus in the diet has a positive effect on treatment, slowing down the growth of connective tissue in the kidneys and the appearance of chronic or acute intoxication. Spicy, fatty, canned and pickled foods put a heavy burden on the urinary system. Water must be consumed in sufficient quantities, in the morning the intake of water starts all the processes in the body and cleanses the body of toxins that have accumulated during the night. However, with rapid weight gain, due to edema, it is necessary to reduce fluid intake for the time the cause is eliminated.

About vitamins and cholesterol

A very important point in nutrition is the intake of foods that lower cholesterol levels.

During the period of illness and treatment, the human body is deprived of many useful substances. Therefore, it is necessary to take vitamin supplements, including trace elements of iron, zinc, selenium, calcium. Include in the diet foods rich in iron: grapes, beets, pomegranates. An increase in cholesterol-lowering foods will be very important in nutrition: cabbage of various varieties, greens, green wheat germ. In addition, the rejection of fast carbohydrates lowers the level of cholesterol and insulin in the blood.

Meat dishes

Favorable vegetarian and vegan vegetable dishes with or without grains. Unfavorable meat, mushroom dishes, eggs. When switching to vegetable protein, fish soups and broths are allowed. Sausage products, canned meat, salted and smoked fish are prohibited. It is important to completely eliminate dairy products.

Cereals and flour products

All whole grains are good, especially gluten-free ones: millet (millet), buckwheat, amaranth, quinoa, chia, brown rice, all legumes are good. It is necessary to abandon white rice, oatmeal, instant cereal is especially harmful. Gluten cereals are undesirable: corn, wheat, barley, oatmeal. Durum wheat pasta is allowed. You can use whole grain unleavened bread or crispbread. All bakery products with sugar, yeast, baked from white and black refined flour are prohibited.

Dried fruits and honey, as sweets, it is desirable to use with kidney nephropathy.

In the first half, it is favorable to use natural sweets: fruits, berries, dried fruits, honey. However, with the infectious nature of the disease, it is worth abandoning them. Chocolate, muesli, condensed milk, sweets, cakes, cookies, any desserts and confectionery with sugar, diabetic products with a sugar substitute should be completely excluded.

Diabetic nephropathy is the general name for most of the kidney complications of diabetes. This term describes diabetic lesions of the filtering elements of the kidneys (glomeruli and tubules), as well as the vessels that feed them.

Diabetic nephropathy is dangerous because it can lead to the final (terminal) stage of renal failure. In this case, the patient will need to undergo dialysis or kidney transplantation.

Diabetic nephropathy is one of the frequent causes of early death and disability in patients. Diabetes is far from the only cause of kidney problems. But among those undergoing dialysis and standing in line for a donor kidney for transplantation, diabetics are the most. One of the reasons for this is a significant increase in the incidence of type 2 diabetes.

Reasons for the development of diabetic nephropathy:

• elevated blood sugar in the patient;
• poor levels of cholesterol and triglycerides in the blood;
• high blood pressure (check out our sister site on hypertension);
• anemia, even relatively “mild” (hemoglobin in the blood< 13,0 г/литр) ;
• smoking (!).

Diabetes can have a damaging effect on the kidneys for a very long time, up to 20 years, without causing the patient any discomfort. Symptoms of diabetic nephropathy appear when kidney failure has already developed. If the patient has signs of kidney failure, then this means that metabolic waste accumulates in the blood. Because the affected kidneys cannot cope with their filtration.

Stages of diabetic nephropathy. Analyzes and diagnostics

Almost all diabetics need to take tests every year that monitor kidney function. If diabetic nephropathy develops, it is very important to detect it at an early stage, while the patient does not yet feel symptoms. The sooner treatment for diabetic nephropathy is started, the greater the chance of success, i.e. that the patient will be able to live without dialysis or a kidney transplant.

In 2000, the Ministry of Health of the Russian Federation approved the classification of diabetic nephropathy by stages. It included the following statements:

• stage of microalbuminuria;
• stage of proteinuria with preserved nitrogen excretion function of the kidneys;
• stage of chronic renal failure (treatment with dialysis or kidney transplantation).

Later, experts began to use a more detailed foreign classification of kidney complications of diabetes. It distinguishes not 3, but 5 stages of diabetic nephropathy. See stages of chronic kidney disease for more details. What stage of diabetic nephropathy a particular patient has depends on his glomerular filtration rate (here it is described in detail how it is determined). This is the most important indicator that shows how well the kidney function is preserved.

At the stage of diagnosis of diabetic nephropathy, it is important for a doctor to understand whether kidney damage is caused by diabetes or other causes. Differential diagnosis of diabetic nephropathy with other kidney diseases should be carried out:

• chronic pyelonephritis (infectious inflammation of the kidneys);
• kidney tuberculosis;
• acute and chronic glomerulonephritis.

Signs of chronic pyelonephritis:

• symptoms of intoxication of the body (weakness, thirst, nausea, vomiting, headache);
• pain in the lumbar region and abdomen on the side of the affected kidney;
• in ⅓ of patients - frequent, painful urination;
• tests show the presence of leukocytes and bacteria in the urine;
• characteristic picture on ultrasound of the kidneys.

Features of kidney tuberculosis:

• in the urine - leukocytes and mycobacterium tuberculosis;
• with excretory urography (X-ray of the kidneys with intravenous administration of a contrast agent) - a characteristic picture.

Diet for complications of diabetes on the kidneys

In many cases of diabetic kidney problems, limiting salt intake can help lower blood pressure, reduce swelling, and slow the progression of diabetic nephropathy. If your blood pressure is normal, then eat no more than 5-6 grams of salt per day. If you already have hypertension, then limit your salt intake to 2-3 grams per day.

Now the most important thing. Official medicine recommends a “balanced” diet for diabetes, and even lower protein intake for diabetic nephropathy. We suggest that you consider using a low-carbohydrate diet to effectively bring your blood sugar back down to normal. This can be done at a glomerular filtration rate above 40-60 ml / min / 1.73 m2. In the article "Diet for the Kidneys in Diabetes" this important topic is described in detail.

Treatment of diabetic nephropathy

The main way to prevent and treat diabetic nephropathy is to lower blood sugar and then keep it close to normal for healthy people. Above, you learned how this can be done with a low-carbohydrate diet. If the patient's blood glucose level is chronically elevated or fluctuates from high to hypoglycemia all the time, all other measures will be of little use.

Medications to treat diabetic nephropathy

To control arterial hypertension, as well as intraglomerular increased pressure in the kidneys, diabetes is often prescribed drugs - ACE inhibitors. These drugs not only lower blood pressure, but also protect the kidneys and heart. Their use reduces the risk of terminal renal failure. Long-acting ACE inhibitors seem to work better than captopril, which needs to be taken 3-4 times a day.

If, as a result of taking a drug from the group of ACE inhibitors, the patient develops a dry cough, then the drug is replaced with an angiotensin-II receptor blocker. Drugs in this group are more expensive than ACE inhibitors, but they cause side effects much less often. They protect the kidneys and heart with about the same efficiency.

The target blood pressure level for diabetics is 130/80 and below. Typically, in patients with type 2 diabetes, it can only be achieved using a combination of drugs. It may consist of an ACE inhibitor and drugs "from pressure" of other groups: diuretics, beta-blockers, calcium antagonists. ACE inhibitors and angiotensin receptor blockers are not recommended to be used together. You can read about combination medicines for hypertension that are recommended for use in diabetes here. The final decision on which pills to prescribe is made only by the doctor.

How kidney problems affect diabetes management

If a patient has diabetic nephropathy, then the methods of treating diabetes change significantly. Because many drugs need to be canceled or their dosage reduced. If the glomerular filtration rate is significantly reduced, then the dosage of insulin should be reduced, because weak kidneys excrete it much more slowly.

Please note that the popular type 2 diabetes drug metformin (Siofor, Glucophage) can only be used at a glomerular filtration rate above 60 ml / min / 1.73 m2. If the patient's kidney function is weakened, then the risk of lactic acidosis, a very dangerous complication, increases. In such situations, metformin is canceled.

If the patient's tests showed anemia, then it must be treated, and this will slow down the development of diabetic nephropathy. The patient is prescribed drugs that stimulate erythropoiesis, i.e., the production of red blood cells in the bone marrow. This not only reduces the risk of kidney failure, but also generally improves the quality of life in general. If the diabetic is not yet on dialysis, iron supplements may also be prescribed.

If preventive treatment of diabetic nephropathy does not help, then kidney failure develops. In such a situation, the patient has to undergo dialysis, and if possible, then a kidney transplant. On the issue of kidney transplantation, we have a separate article, and we will briefly discuss hemodialysis and peritoneal dialysis below.

Hemodialysis and peritoneal dialysis

During a hemodialysis procedure, a catheter is inserted into the patient's artery. It is connected to an external filtering device that purifies the blood instead of the kidneys. After cleaning, the blood is sent back to the patient's bloodstream. Hemodialysis can only be performed in a hospital setting. It can cause low blood pressure or infection.

Peritoneal dialysis is when a tube is inserted into the abdominal cavity instead of an artery. Then a large amount of liquid is fed into it by the drip method. This is a special liquid that draws out waste. They are removed as fluid drains from the cavity. Peritoneal dialysis should be done every day. It is associated with the risk of infection at the points where the tube enters the abdominal cavity.

In diabetes mellitus, fluid retention, nitrogen and electrolyte imbalances develop at higher values ​​of the glomerular filtration rate. This means that patients with diabetes should be transferred to dialysis earlier than patients with other renal pathologies. The choice of dialysis method depends on the preferences of the doctor, and for patients there is not much difference.

When to start kidney replacement therapy (dialysis or kidney transplant) in people with diabetes:

• The glomerular filtration rate of the kidneys< 15 мл/мин/1,73 м2;
• Elevated blood potassium levels (> 6.5 mmol / l), which cannot be reduced by conservative methods of treatment;
• Severe fluid retention in the body with a risk of developing pulmonary edema;
• Obvious symptoms of protein-energy deficiency.

Blood test targets for diabetic patients on dialysis:

• Glycated hemoglobin - less than 8%;
• Blood hemoglobin - 110-120 g / l;
• Parathormone - 150-300 pg / ml;
• Phosphorus - 1.13–1.78 mmol / l;
• Total calcium - 2.10-2.37 mmol / l;
• Product Ca × P = Less than 4.44 mmol2/L2.

If renal anemia develops in diabetics on dialysis, then drugs that stimulate erythropoiesis are prescribed (epoetin-alpha, epoetin-beta, methoxypolyethylene glycol epoetin-beta, epoetin-omega, darbepoetin-alpha), as well as iron preparations in tablets or in the form of injections. They try to keep blood pressure below 140/90 mm Hg. Art., ACE inhibitors and angiotensin-II receptor blockers remain the drugs of choice for the treatment of hypertension. For more information, read the article "Hypertension in Type 1 and Type 2 Diabetes".

Hemodialysis or peritoneal dialysis should only be considered as a temporary step in preparation for kidney transplantation. After a kidney transplant for the period of functioning of the graft, the patient is completely cured of renal failure. Diabetic nephropathy is stabilizing, the survival rate of patients is increasing.

When planning a kidney transplant for diabetes, doctors try to estimate how likely the patient is to have a cardiovascular event (heart attack or stroke) during or after surgery. To do this, the patient undergoes various examinations, including an ECG with exercise.

Often the results of these examinations show that the vessels that feed the heart and / or brain are too affected by atherosclerosis. See the article “Stenosis of the renal arteries” for more details. In this case, it is recommended to surgically restore the patency of these vessels before kidney transplantation.

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Unfortunately, diabetes often causes complications to the kidneys, and they are very dangerous. Kidney damage in diabetes mellitus causes huge problems for the patient. Because for the treatment of kidney failure, you have to regularly undergo dialysis procedures. If you're lucky to find a donor, then they do a kidney transplant. Kidney disease in diabetes is often the cause of painful death of patients.

If blood sugar is well controlled in diabetes, complications to the kidneys can be avoided.

The good news is that if you keep your blood sugar close to normal, you can almost certainly prevent kidney damage. To do this, you need to actively take care of your health.

You will also be pleased that measures to prevent kidney disease also serve to prevent other complications of diabetes.

How Diabetes Causes Kidney Damage

In each human kidney there are hundreds of thousands of so-called "glomeruli". These are filters that purify the blood of waste and toxins. Blood passes under pressure through the small capillaries of the glomeruli and is filtered. Most of the fluid and normal blood components are returned to the body. And the waste, along with a small amount of fluid, passes from the kidneys to the bladder. Then they are removed outside through the urethra.

In diabetes, blood with a high sugar content passes through the kidneys. Glucose pulls a lot of fluid with it, which causes increased pressure inside each glomerulus. Therefore, the glomerular filtration rate - this is the most important indicator of the quality of kidney function - often increases in the early stages of diabetes. Surrounding the glomeruli is a tissue called the glomerular basement membrane. And this membrane is abnormally thickened, like other tissues that are adjacent to it. As a result, the capillaries inside the glomeruli are gradually forced out. The fewer active glomeruli remain, the worse the kidneys filter the blood. Since there is a significant reserve of glomeruli in the human kidneys, the process of blood purification continues.

In the end, the kidneys are exhausted so that they appear kidney failure symptoms:

• lethargy;
• headache;
• vomit;
• diarrhea;
• the skin itches;
• metallic taste in the mouth;
• bad breath, reminiscent of the smell of urine;
• shortness of breath, even with minimal physical exertion and rest;
• spasms and leg cramps, especially in the evenings, before going to bed;
• loss of consciousness, coma.

This happens, as a rule, after 15-20 years of diabetes, if blood sugar has been elevated, that is, diabetes has been poorly treated. Uricemia occurs, a buildup of nitrogenous waste products in the blood that the affected kidneys can no longer filter.

Analyzes and examinations of the kidneys in diabetes mellitus

To check the kidneys in diabetes, you need to pass the following tests

• blood test for creatinine;
• urinalysis for albumin or microalbumin;
• urinalysis for creatinine.

Knowing the level of creatinine in the blood, it is possible to calculate the glomerular filtration rate of the kidneys. It is also found out whether there is microalbuminuria or not, and the ratio of albumin and creatinine in the urine is calculated. For more information about all these tests and indicators of kidney function, read "What tests to take to check the kidneys" (opens in a separate window).

The earliest sign of kidney problems in diabetes is microalbuminuria. Albumin is a protein whose molecules have a small diameter. Healthy kidneys pass very little of it into the urine. As soon as their work deteriorates even a little, there is more albumin in the urine.

Diagnostic indicators of albuminuria

You should be aware that an increased amount of albumin in the urine may not only be due to kidney damage. If yesterday there was a significant physical activity, then today albuminuria may be higher than normal. This must be taken into account when planning the day of the test. Albuminuria is also increased by: a high-protein diet, fever, urinary tract infections, heart failure, pregnancy. Urine albumin to creatinine ratio is a much more reliable indicator of kidney problems. Read more about it here (opens in a separate window)

If a patient with diabetes has been diagnosed and confirmed several times with microalbuminuria, this means that he has an increased risk of not only kidney failure, but also cardiovascular diseases. If left untreated, then later the filtration capacity of the kidneys weakens even more, and other larger proteins appear in the urine. This is called proteinuria.

The worse the kidneys work, the more creatinine accumulates in the blood. After the glomerular filtration rate has been calculated, it is possible to determine at what stage the patient's kidney damage is.

Stages of chronic kidney disease, depending on the glomerular filtration rate

Notes to the table. Evidence of kidney problems, which show tests and examinations. It can be:

• microalbuminuria;
• proteinuria (the presence of large protein molecules in the urine);
• blood in the urine (after all other causes have been ruled out);
• structural abnormalities, which showed ultrasound of the kidneys;
• glomerulonephritis, which was confirmed by kidney biopsy.

Typically, symptoms do not start until stage 4 of chronic kidney disease. And all the earlier stages proceed without external manifestations. If it is possible to detect kidney problems at an early stage and start treatment on time, then the development of kidney failure can often be prevented. Once again, we strongly recommend that you regularly take tests at least once a year, as described in the section “What tests to take to check the kidneys“. At the same time, you can also check the levels of urea and uric acid in the blood.

Tablets for type 2 diabetes, which are allowed to be used at different stages of kidney disease

Metformin (Siofor, Glucophage)
Glibenclamide, including micronized (Maninil)
Gliclazide and gliclazide MB (Glidiab, Aktos)
Glimepiride (Amaryl)
Gliquidone (Glurenorm)
Glipizide, including prolonged (Movogleken, Glibens retard)
Repaglinide (NovoNorm, Diaglinide)
Nateglinide (Starlix)
Pioglitazone (Aactos)
Sitagliptin (Januvia)
Vildagliptin (Galvus)
Saxagliptin (Ongliza)
Linagliptin (Tragenta)
Exenatide (Byetta)
Liraglutide (Victoza)
Acarbose (Glucobay)
Insulin

Note to the table.

* At 4-5 stages of kidney damage, you need to adjust the dose of the drug. Also, as kidney disease progresses, the breakdown of insulin in the body slows down. This increases the risk of hypoglycemia. Therefore, insulin dosages must be adjusted downwards.

Patients who are at risk of developing renal failure.

Prevention of kidney damage in diabetes

Chronic kidney disease develops in about 1/3 of patients with type 1 and type 2 diabetes, i.e., not all. How likely you are to develop symptoms of kidney failure depends on the results of the tests we described in the previous section. Get tested and discuss the results with your doctor.

What you can do to prevent kidney damage in diabetes:

• keep your blood sugar close to normal - this is the most important thing
• read the article "Diet for the kidneys in diabetes";
• regularly measure blood pressure at home with a tonometer (how to do it correctly so that the result is accurate);
• your blood pressure should be normal, below 130/80;
• take tests that check the functioning of the kidneys at least once a year;
• Do whatever you need to do to control your blood sugar, blood pressure, cholesterol, and blood fats, including taking your doctor's prescription medications.
• stick to the right diet for diabetes (in this matter, the “official” recommendations are very different from ours, read below in this article);
• exercise regularly, try home exercises with light dumbbells, which are absolutely safe for the kidneys;
• drink alcohol “purely symbolically”, never get drunk;
• stop smoking;
• find a good doctor who will "manage" your diabetes and see him regularly.

Studies have convincingly proven that smoking itself is a significant factor that increases the risk of developing kidney failure in diabetes. Quitting smoking is not a formal recommendation, but an urgent need.

Treatment of kidneys in diabetes

The doctor prescribes kidney treatment for diabetes, depending on the stage at which their damage is. The main responsibility for the implementation of prescriptions lies with the patient himself. Something depends on the members of his family.

We list the main directions of treatment of kidney diseases in diabetes:

• intensive control of blood sugar;
• lowering blood pressure to the target level of 130/80 mm Hg. Art. and below;
• adherence to an optimal diet for diabetic kidney problems;
• control of cholesterol and triglycerides (fats) in the blood;
• dialysis;
• kidney transplant.

In the article “Diabetic Nephropathy”, the issue of treating kidneys in diabetes is considered in great detail. See also "Diet for the kidneys in diabetes".

Diabetes and kidneys: what to remember

If there are kidney problems, then blood tests for creatinine and urine tests for microalbuminuria can detect them early. If treatment is started on time, it significantly increases the chances of success. Therefore, the analyzes that are described here (opens in a separate window) should be regularly taken once a year. Consider using a low-carbohydrate diet to normalize your blood sugar. Read more in the article "Diet for the kidneys in diabetes".

Many diabetics who have high blood pressure are helped by limiting salt in the diet in addition to medication. Try reducing your intake of sodium chloride, or table salt, and see what results you get. Each person has their own individual sensitivity to salt.

Another complication, diabetic neuropathy, can damage the nerves that control the bladder. In this case, the function of emptying the bladder is impaired. In the urine that remains all the time, an infection can multiply that damages the kidneys. At the same time, in diabetics who have managed to normalize their blood sugar, neuropathy most often turns out to be reversible, that is, it disappears completely.

If you have difficulty urinating or other signs of a urinary tract infection, contact your doctor immediately. These problems can seriously accelerate the development of kidney complications in diabetes.

The incidence statistics are getting sadder every year! The Russian Diabetes Association states that every tenth inhabitant of our country has diabetes. But the cruel truth is that it is not the disease itself that is terrible, but its complications and the lifestyle to which it leads. How can you overcome this disease tells in an interview ...

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The kidneys are a very important organ. They function on the principle of a filter, removing the products of protein metabolism from the blood. In the kidneys there are a large number of small vessels - capillaries, which make up the glomeruli of the kidneys with membranes that have small holes. It is in these holes that the products of protein metabolism - urea and creatinine, excreted from the body with urine, enter. Vital erythrocytes, proteins do not penetrate through the holes and continue to be in the blood.

A diet for kidney nephropathy is a very important component of maintaining health, helping to normalize metabolic processes. Therapeutic nutrition is an integral component of treatment that improves the effect of drugs. Any kidney disease disrupts the functioning of various organs and systems in the body. First of all, this correlates with changes in the process of accumulation of metabolic products in the blood and disturbances in the water-electrolyte and acid balance.

These changes provoke the occurrence of the following symptoms:

• the formation of puffiness;
• increased blood pressure;
• manifestation of intoxication in the body through its own metabolic products.

Treatment of pathology

First of all, at the beginning of the treatment of nephropathy, it is required to eliminate the factors that provoked the appearance of nephropathy. It is necessary to stop taking medications that could contribute to the development of pathology, to the extent possible, eliminate the impact on the body of heavy metals, radiation, as well as other industrial or domestic exposures.

Also, for the implementation of successful treatment, it is necessary to constantly monitor the course of gout. Diabetes mellitus, if any.

It is important to correct the concentration of fats in the blood and purine metabolism.

Patients need to follow a special diet containing proteins, fats, vitamins and carbohydrates. It is important to avoid excessive salt and liquid intake.

Diet for nephropathy

A strict diet for kidney damage is prescribed for a patient with chronic kidney failure and glomerulonephritis. With other pathologies of the kidneys, it is not necessary to seriously limit the diet, it is enough to reduce the consumption of hot spices, salt and spices.

Nutrition in the development of kidney problems requires a decrease in the amount of proteins that come with food. During protein metabolism, nitrogenous slags begin to form, which can be excreted with great difficulty by damaged kidneys and therefore gradually accumulate in the blood. At the same time, proteins are the building material for cells in the body, so they need to be limited, not completely eliminated. From protein products, it is recommended to use low-fat varieties of fish and meat, but to refuse fried foods.

A strict protein diet for kidney pathologies can be observed for no more than one to two weeks, because a person’s well-being can deteriorate greatly from a sharp rejection of protein foods. With a slight violation of the kidneys, protein restriction is not required, it is enough to organize a fasting day once a week.

Another important point of nutrition in nephropathy is its calorie content. Products should remain high-calorie and the total caloric content of food consumed per day should be approximately 3500 kcal. The main focus should be on the consumption of fats and carbohydrates. A decrease in calorie intake provokes the consumption of its own proteins, and therefore, the formation of toxic metabolic products begins in the body, so the load on the kidneys increases significantly.

By itself, food should remain fractional and regular, you need to eat 4-6 times a day.

Salt intake should be limited only with high blood pressure and the formation of severe edema. At the same time, it is not necessary to add salt to the dishes during the cooking process, it is better to add salt to them already during use.

Many prepared foods, such as bread and other baked goods, contain a lot of salt, so it's best to make your own baked goods at home. In this regard, it is forbidden to eat sausages, smoked meats, marinades, hard cheeses, salted fish, drink mineral water and cocoa.

It is better to give up foods rich in potassium and phosphorus, especially nuts, dried fruits, cottage cheese, bananas, etc.

You need to give preference to the following products: pasta, cereals, boiled, fresh and stewed vegetables, berries, butter and vegetable oil, jelly and compotes, rosehip broth, weak coffee and tea.

Dietary nutrition for kidney damage involves the restriction or complete exclusion of the following foods: mushrooms, chocolate, chicken and meat broth, onions and garlic, radishes, legumes, spicy and heavily peppered dishes. These products contain essential oils that irritate the kidney tissue. During cooking, you must use cinnamon, bay leaf and a little fried onion.

Diabetic nephropathy refers to kidney damage caused by years of diabetes. In addition to drug treatment, with this disease, you need to follow a diet, which plays an important role in maintaining kidney function.

Nutrition in this case implies the restriction of simple carbohydrates. Diabetic products will also benefit. Sugar-containing drinks are prohibited. It is recommended to drink more unsweetened juices (natural), which are rich in potassium.

If diabetic nephropathy appeared on the background of arterial hypertension, then it is necessary to follow a low-salt diet.

Diet at an early stage of nephropathy

At this stage, the restoration of intrarenal dynamics directly depends on proper dietary nutrition. Restricted protein intake is shown here. If hypertension is diagnosed, then it is necessary to limit salt intake to about four grams per day. Refusal of salted or low-salted vegetables and fish will also have a beneficial effect. Food should be prepared exclusively from fresh products without salting. Nutritionists recommend - the total calorie content of food should not exceed more than 2500 calories.

Diet at the stage of proteinuria

At this stage, a low-protein diet is necessary, which is part of symptomatic therapy. Protein intake is reduced to 0.7 g per 1 kg of human weight. Salt is also limited to two grams per day. In other words, you have to cook not only food without salt, but also switch to salt-free bread. It is recommended to eat foods that have a low salt content, namely: rice, carrots, oats, semolina, cabbage (white or cauliflower), potatoes, beets. From meat products, veal will become healthy food, and from fish products - perch, pike, carp, pike perch.

Diet in chronic renal failure

At this stage, dietary therapy is reduced to limiting protein to 0.3 g per kilogram of human weight. Phosphate restriction is quite effective. Although this in some cases leads to a sharp protein starvation and apparently reduces the quality of life of people who have a chronic stage of renal failure. To avoid protein starvation syndrome, it is necessary to use drugs that contain essential essential amino acids.

Diet for kidney nephropathy in diabetes