WHAT IS END STAGE RENAL FAILURE???

End stage renal failure is a complete or almost complete renal failure. Those who had ESRF will depend on dialysis for a lifetime unless they undergo kidney transplantation.

WHAT ARE THE RISK FACTOR OF DEVELOPING ESRF??

Risk factors for ESRF include:

•   Diabetes
•  Diabetes is the biggest risk factor in developing ESRF. In diabetes, body doesn’t use glucose (sugar) very well thus, that glucose will remain in the blood and become harmful to the body. 
Nearly one –third of people who develop ESRF have diabetes.

•  High blood pressure (hypertension)
• High blood pressure is the second leading cause of kidney failure. This condition can affect kidney function where it can cause damage to small blood vessels at the kidney thus preventing kidney from filtering the waste product in the blood.

•   History of glomerular disease
•  This is third leading cause of glomerular disease. Glomerular disease will damage glomeruli which function to filter blood in the kidney.

•   Drug use
•  Extensive use of over the counter pain medicine or abuse of illegal drugs can lead to kidney 
  failure.
  
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KERATAN AKHBAR

MEDICAL NUTRITION THERAPY FOR ACUTE RENAL FAILURE

What is the goal of dietary management for acute renal failure patient??? The recommendation for both micro and macronutrient below which is established for acute renal patient intended to limit further renal injury and also to prevent malnutrition.
Come and have a look about the recommended amount of both micro and macronutrient!

Nutrient	Suggested prescription	Rationale
Energy	30- 35 kcal/kg body weight	Based on nutritional status and stress level of the patient
Protein	Nondialysis patients    :  0.8-1.2 g/kg Hemodialysis patients : 1.2-1.5 g/kg CAPD patients             : 1.2-1.3 g/kg CCPD patients             : 1.2-1.3 g/kg CRRT patients              : 1.5-2.0g/kg	Increase as GFR is back to normal. High biological value protein should be provided for at least 60%
Sodium	1.1-1.3 g/day	Depending on urinary output, blood pressure, edema, dialysis and serum sodium level; replace loss in diuretic phase. Excess sodium can increase fluid retention.
Potassium	2-3 g/day	Depending on urinary output, dialysis and serum potassium level; replace loss in diuretic phase. Excess potassium can result in severe cardiac and neuromuscular complications.
Fluid	24- hours urine output + 500 ml	Based on urinary sodium and total urine output
Phosphorus	Limit as needed	Excess phosphorus may result of decreased renal phosphorus excretion and increased endogenous release of phosphates.  It can also interact with calcium to weaken bones. It has negative effects on the heart tissue, blood vessels, and lungs. May need supplementation with tube feeding and/or with TPN.
Magnesium	Limit as needed	Excess magnesium can affect neuromuscular, cardiovascular and neurologic systems
Calcium	1.0- 1.5 g/day	May require supplementation as needed
Vitamin/ Minerals	Supplement as needed	May need to supplement water soluble and fat soluble vitamin, especially vitamin B & C

This is the recommendation of intake for acute renal failure patient and can be used as a guidance for daily dietary intake. If you can't understand on how this recommendation works, don't worry! Go and meet your dietitian and she/ he will determine how much to take, which food is appropriate for your diet and which to avoid based on your individual needs.
Meet your dietitian now and he/she will help you out on your diet =)

FOSFORUS DAN PENYAKIT BUAH PINGGANG

Apa itu fosforus??
- Fosforus merupakan sejenis mineral yang membantu mengekalkan kekuatan dan kesihatan tulang.

Apakah kaitan di antara fosforus dan penyakit buah pinggang?
- Kegagalan buah pinggang boleh menyebabkan aras fosfat di dalm darah meningkat. keadaan ini boleh mengakibatkan kegatalan kulit, sakit sendi dan kehilangan kalsium daripada tulang. Oleh itu, mereka yang mempunyai penyakit buah pinggang perlu menghadkan pengambilan makanan yang mengandungi kandungan fosforus yang tinggi dan sederhana.

Di bawah merupakan panduan pengambilan fosforus bagi pesakit buah pinggang:

PANDUAN UNTUK MEMILIH MAKANAN YANG MENGANDUNGI FOSFORUS
Daripada memilih makan yang tinggi kandungan fosfat	… pilih makanan yang mengandungi rendah kandungan fosfat
Tenusu dan tenusu gantian
8 auns susu	8 auns krimer bukan tenusu atau 4 auns susu
½ cawan aiskrim	½ cawan sorbet atau 1 popsikel(es loli)
½ cawan kastard atau puddingyang dibuat dari susu	½ cawan pudding atau kastard yang dibuat dari krimer bukan tenusu
Susu bermalt	Teh, epal sider panas
Beras perang	Beras putih, barli
Biskut: beli di kedai, bercampur dan disejukkan	Biskut: buat sendiri- gunakan penukaran serbuk penaik seperti di bawah**)
Mufin: semua beli dikedai, campuran, bran buatan sendiri dan perisa bran oat	Mufin: buatan sendiri, dibuat menggunakan tepung putih (gunakan penukaran serbuk penaik seperti di bawah**)
Daging dan protin lain
Ikan kap, udang laut, hati lembu, hati ayam, telur ikan, tiram, ikan sardine dan organ haiwan	Daging lembu yang tidak berperisa, daging ayam, daging babi, ayam belanda, daging anak lembu, ikan dan telur
Sayur- sayuran dan buah- buahan
Kacang lima/ kacang pinto	Sayuran campuran atau kacang hijau
Buahan kering, prun, jus buah prun	Buahan segar atau buahan dalam tin seperti epal, pir, beri, anggur, tembikai,
Minuman
Minuman ringan cola	Minuman ringan bukan cola (ale halia, soda berperasa lemon, root beer)
Teh ais dengan tambahan fosfat	Teh ais buatan sendiri
Koko, coklat panas	Teh, cider epal panas
Snek dan item lain (pelbagai)
Kacang	Popcorn tanpa garam
Kacang, mentega kacang, bijana atau biji bunga matahari. Elakkan makan biji labu	Popcorn tanpa garam, chips jagung tanpa garam
Bar coklat	Gula-gula keras, gula- gula berperisa buah atau jeli kacang

** serbuk penaik mengandungi kandungan fosfat yang tinggi. sebagai alternatif untuk mengurangkan kandungan fosfat, gantikan 1 sudu teh serbuk penaik dengan campuran 1/4 sudu teh baking soda dan 1/2 
sudu teh tartar krim. 

pelbagaikan pengambilan sayur- sayuran

senarai makanan yang tinggi kandungan fosforus

PHOSPHORUS AND KIDNEY DISEASE

What is phosphorus?
- phosphorus is a minerals which help to keep bones strong and healthy.

What is the relationship between phosphorus and kidney disease?
- decline in kidney function lead to a rise in phosphate blood level which causing itchy skin, painful joints and loss of calcium from bone. Thus, those who have kidney disease have to limit amount of high and moderate phosphate- containing food.

Below are some guidelines for kidney patient in choosing phosphate food in their diet.

PHOSPHORUS GUIDELINE FOR CHOOSING FOOD
Instead of these higher phosphorus food	… you can eat these lower phosphorus food
Dairy and dairy-substitutes
8 ounces milk	8 ounces non-dairy creamer or 4 ounces milk
½ cup ice cream	½ cup sherbet (sorbet) or 1 popsicle
½ cup custard or pudding made with milk	½ cup pudding or custard made with non-dairy creamer
Malted milk	Tea, hot apple cider
Brown rice	White rice, barley
Biscuits: store-bought, mixes and refrigerated	Biscuits: homemade (use baking powder substitute below**)
Muffins: all store-bought, mixes, and homemade bran and oat bran flavours	Muffins: homemade, made with white flour (use baking powder substitute below**)
Meat and other proteins
Carp, crayfish, beef liver, chicken liver, fish roe, organ meats, oysters, sardines	Unseasoned beef, chicken, pork, turkey, veal, fish, eggs
Fruit and vegetables
Lima or pinto beans	Mixed vegetables or green beans
Dried fruits, prunes, prune juice	Fresh or canned fruits such as apples, pears, berries, grapes, watermelon, pineapple
Beverages
Cola soft drinks	Non-cola soft drinks (ginger ale, lemon/lime flavoured soda, root beer)
Iced tea with phosphate additives	Homemade iced tea
Cocoa, hot chocolate	Tea, hot apple cider
Snacks and miscellaneous items
Peanuts	Unsalted popcorns
Nuts, peanut butter, sesame or sunflower seeds; avoid pumpkin seeds	Unsalted popcorn, unsalted pretzels, unsalted corn chips
Chocolate bars	Hard candy, fruit flavoured candy or jelly beans

**Since baking powder is high in phosphorus, try this low phosphorus alternative: use ¼ tsp baking soda + ½ tsp cream of tartar instead of 1 tsp baking powder

do consume variety of vegetables!

list of high phosphorus food

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