Diet taboos for kidney disease

To reduce the metabolic burden on the kidneys as much as possible and avoid aggravation of complications such as electrolyte disorders and proteinuria, it is necessary to dynamically adjust the kidney disease stage, pathological type, current liver and kidney function, and electrolyte indicators. There are no foods that all patients must not touch.

I met Uncle Zhang, a 62-year-old stage 2 patient with membranous nephropathy, during a follow-up visit a while ago. When he was first diagnosed, he heard from an old patient in the same ward that "contamination of beans with kidney disease will aggravate proteinuria." So he blacklisted all soy products and replaced the soy milk he had drank for more than ten years with bland white porridge. Even the soybeans used in braised noodles at home had to be picked out. After three months of reexamination, the 24-hour urinary protein quantification did not drop, but the albumin dropped from 32g/L to 28g/L. My legs were weak and I couldn't walk at all times. Later, I went to the nutrition department to adjust the plan. I added soft tofu twice a week and freshly ground soy milk once a week. The total protein intake was strictly controlled at 0.8g per kilogram of body weight per day. When I checked again two months later, the albumin increased back to 35g/L, and the urinary protein was also stable within 0.5g.

Having said this, someone must ask, is the "You must not eat soy products with kidney disease" that has been circulated on the Internet for more than ten years a rumor? In fact, it is not completely wrong, but the concept is outdated. The traditional nutrition concept for kidney disease does believe that plant protein metabolism has a lot of waste products and will increase the burden of kidney filtration, so it is recommended to completely ban soy products. ； However, the evidence of evidence-based medicine in the past 10 years has already updated the conclusion: the protein of soybeans, such as soybeans, black beans, and green beans, is a complete high-quality protein. The amino acid pattern matches the needs of the human body very well, and is even lower than the saturated fat content of red meat. It is more suitable for patients with kidney disease combined with hyperlipidemia. As long as the total daily protein intake is controlled, they can eat normally. Only patients with acute attacks of gout or uremic patients without dialysis need to appropriately reduce their intake.

In addition to this controversial point that has been quarreling for many years, the first problem that most patients with kidney disease have is sodium intake. To tell the truth, last year there was a 24-year-old girl with IgA nephropathy, whose normal indicators were very stable. She opened two cans of iced yellow peaches at home during the National Day, and ate half a bag of dried radish pickled by her mother with the cans. The next day, her face was swollen with only a slit left for her eyes. Her blood pressure soared to 148/96. She rushed to the emergency room in a panic. Too much sodium in a short period of time caused water and sodium retention. This does not mean that everyone should eat salt-free meals every day. Generally, patients with stable conditions should control their daily salt intake to less than 3g, which is about the amount of a beer cap. They should avoid touching invisible high-sodium items such as pickles, fermented bean curd, cured meats, processed snacks, and takeaways. When edema and high blood pressure are severe, the stricter regulations should be applied. If you have early-stage kidney disease, no edema, or high blood pressure, it is not a big deal to eat a mouthful of braised meat to satisfy your craving occasionally. Just don't show off with a pot.

Don’t just focus on the visible salt, the adjustment of potassium and phosphorus intake depends more on the person. I have met many patients who have just been diagnosed with early-stage kidney disease. Their creatinine is all normal and they don’t have high potassium problems. They just black out bananas, oranges, and potatoes. It’s really unnecessary. Only when the kidney function drops to stage 3 and beyond, and the glomerular filtration rate is lower than 60ml/min·1.73m², and the kidney's ability to excrete potassium and phosphorus decreases, will it be necessary to appropriately limit high-potassium and high-phosphorus foods, such as spinach, seaweed, avocado, nuts, animal offal, etc. If you have started regular dialysis, you don't need to be so strict with protein cards, and you even need to eat more high-quality protein to prevent malnutrition from dragging down your immunity.

Another taboo that has a very high rate of being tripped up is not to blindly take so-called "kidney-tonifying" folk remedies. I have seen many patients whose indicators were very stable, but after taking "supplements" blindly for half a year, their creatinine increased by more than 200. Pork kidney itself is a food with high phosphorus and high purine. Not only can it not replenish the kidneys, but it will put a burden on the kidneys when metabolized. Unknown ingredients of unknown origin may also be added to the unknown ingredients that are nephrotoxic. If you really want to adjust your diet, go to the nutrition department of a regular hospital and customize recipes according to your indicators. It is much more reliable than watching ten short health videos.

In fact, many of the kidney disease patients I have come into contact with tend to go to two extremes. They either don't care about any taboos and only eat hot pot and barbecue, or they dare not eat anything. In the end, malnutrition drags down the body. Diet for kidney disease is never a black-and-white judgment question, but a dynamic adjustment question: If your blood potassium is high during this review, just eat less high-potassium foods in the past two weeks. If it goes down during the next review, it doesn't matter if you eat some oranges appropriately. ； The protein in your urine has been a little floating recently, so just eat less fat meat and get more high-quality protein. There is really no need to live like a walking fasting list. Occasionally, you will be craving for a small cake or a few mouthfuls of braised meat. As long as you don’t do it every once in a while, there won’t be any big problems. After all, being able to eat happily is the basis for good treatment.