Diet in chronic kidney disease

Q: My aunt aged 43 years has been diagnosed with some kidney problem. Her reports on 1.10.2001 revealed blood urea: 57.5 mg%; S. creatinine: 2.6 mg% and serum triglyceride: 247 mg%. Presence of albumin and pus cells 5-6/h.p.f was noted on urine examination. According to her ultra-sound report dated 19.1.2002 her right kidney measures 7.4 X 3.6 cm and left kidney measures 9.0 X 3.7 cm. Both kidney show increased parenchymal echogenicity with partial loss of cortico-medullary differentiation. Few small cortical cysts are seen in the right kidney. No hydronephrosis/calculi seen in both the kidneys. IMPRESSION: Imaging findings are suggestive of medical renal disease. Is this suggestive of kidney failure? What are her prospects of improvement? Should she eat things containing lesser proteins? Please advise what diet she should take and what things should she should avoid. What medicines would you prescribe?

A:Your aunt has kidney function impairment and both kidneys show the dysfunction. Right kidney is small and shrunken probably as a result of infection. Your aunt, I hope has been seen by a kidney specialist. She would need a DMSA scan. If her blood pressure is high, then the blood pressure needs to be controlled very diligently to less than 130/80 mmHg. She would also need to get a 24 hrs urine protein and creatinine clearance done. She should take 0.7gm/kg i.e. 45 gms protein (high biological value) and 35k cal/kg i.e. (2275 calories). She should avoid dry fruits and fruit juices and citrus fruits. The fruits she can have are apple, papaya and guava. Her salt and fluid intake will be guided by her blood pressure and state of water in the body. We do not have any methods to stop progressive nature of the chronic kidney diseases and these usually progress relentlessly. We can slow down the rate of deterioration by controlling blood pressure and the dietary regimen.