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

                    Thanks for viewing our blog..have a nice day!                

APAKAH YANG DIMAKSUDKAN DENGAN KEGAGALAN BUAH PINGGANG TAHAP AKHIR??

 Kegagalan buah pinggang tahap  akhir berlaku apabila buah pinggang tidak dapat berfungsi sepenuhnya. Pesakit yang telah berada di tahap akhir kegagalan buah pinggang terpaksa bergantung kepada dialisis untuk seumur hidup melainkan mereka menjalani pembedahan pemindahan buah pinggang.

SIAPAKAH YANG BERISIKO UNTUK MENGALAMI KEGAGALAN BUAH PINGGANG TAHAP AKHIR?

Penghidap kencing manis

•   kencing manis merupakan penyebab utama yang boleh membawa kepada kegagalan buah pinggang tahap akhir. Mereka yang menghidap diabetes tidak dapat mengunakan glukos dengan sebaiknye menyebabkan glukos berkumpul di dalam darah. Keadaan ini boleh membawa bahaya kepada system badan. Satu pertiga daripada mereka yang mengalami kegagalan buah pinggang tahap akhir merupakan penghidap kencing manis.

Mereka yang mempunyai tekanan darah tinggi (hipertensi)

• tekanan darah tinggi adalah penyebab kedua yang boleh membawa kepada kegagalan buah pinggang. Keadaan ini boleh mengganggu fungsi buah pinggang di mana ia boleh merosakkan salur darah yang berada di kawasan buah pinggang, menyebabkan buah pinggang gagal untuk menapis bahan buangan yang terkumpul di dalam darah.

Mereka yang mempunyai sejarah penyakit glomerular

•  keadaan ini merupakan penyebab ketiga  kepada kegagalan buah pinggang di mana ia boleh merosakkan glomeruli yang berfungsi untuk menapis darah di dalam buah pinggang.

Pengambilan ubat- ubatan

•  pengambilan ubat- ubatan secara berlebihan yang didapati secara terus dari kaunter ataupun penyalahgunaan ubat- ubatan yang tidak dibenarkan boleh membawa kepada kegagalan buah pinggang.

MEDICAL NUTRITION THERAPHY FOR ACUTE RENAL FAILURE

Pengurusan diet untuk pesakit kegagalan buah pinggang akut bertujuan untuk mengelakkan buah pinggang dari mengalami kerosakan yang lebih teruk dan juga untuk memastikan pesakit mendapat nutrisi yang secukupnya. 

Disertakan di sini adalah kuantiti pengambilan mikro dan makronutrient yang disarankan untuk pesakit buah pinggang akut:
 

Nutrien	Preskripsi yang dicadangkan	Rasional
Tenaga	30- 35 kcal/kg berat badan	Berdasarkan kepada status pemakanan dan tahap stress pesakit.
Protein	Pesakit tanpa dialisis   :               0.8-1.2 g/kg Pesakit dengan haemodialisis :    1.2-1.5 g/kg Pesakit dengan CAPD : 1.2-1.3 g/kg Pesakit dengan CCPD : 1.2-1.3 g/kg Pesakit dengan CRRT  : 1.5-2.0g/kg	Pengambilan meningkat apabila GFR (kadar penapisan glomerular) kembali normal. Protein yang tinggi nilai biologi perlu diambil sekurang- kurangnya 60%.
Sodium	2-3 g sehari	Bergantung kepada pengeluaran air kencing, tekanan darah, edema, dialysis dan paras serum sodium; diperlukan untuk menggantikan sodium yang hilang ketika fasa diuretik Sodium yang berlebihan boleh menyebabkan penahanan cecair di dalam badan.
Potassium	2-3 g sehari	Bergantung kepada pengeluaran air kencing, dialysis dan paras serum potassium; diperlukan untuk menggantikan kehilangan potassium ketika fasa diuretik Potassium yang berlebihan boleh mengakibatkan komplikasi pada jantung dan saraf.
Cecair	24- jam pengeluaran air kencing + 500 ml	Berdasarkan sodium dalam air kencing dan jumlah pengeluaran air kencing.
Fosforus	Hadkan seperti yang diperlukan	Lebihan fosforus boleh menyebabkanpenurunan perkumuhan fosforus oleh buah pinggang dan meningkatkan pembebasan fosfat ke dalam sel.  Fosforus juga boleh bertindakbalas dengan kalsium untuk melemahkan tulang. Fosforus mempunyai kesan negative terhadap tisu jantung, salur darah dan peparu.
Magnesium	Hadkan seperti yang diperlukan	Lebihan magnesium boleh memberi kesan kepada sistem saraf, kardiovaskular dan neurologi.
Kalsium	1.0-1.5 g sehari	Mungkin memerlukan makanan tambahan seperti yang diperlukan.
Vitamin/ Mineral	Tambah seperti yang diperlukan	Mungkin memerlukan suplemen untuk vitamin larut lemak dan larut air terutamanya vitamin B & C

 
Ini merupakan saranan pengambilan makanan untuk pesakit kegagalan buah pinggang akut yang boleh dijadikan panduan dalam pemilihan makanan seharian. Sekiranya anda tidak memahami bagaimana untuk mengaplikasikan saranan ini dalam pemakanan seharian, jangan risau! Dietitian- dietitian terlatih sedia untuk membantu anda.Berjumpalah dengan mereka sekarang dan mereka akan membantu anda sebaik yang mungkin untuk memsatikan anda mendapat pengambilan makanan yang secukupnya berdasarkan keadaan kesihatan dan tubuh badan anda.

PERITONEAL DIALYSIS

This types of dialysis has recently became choices among kidney patient over hemodialysis as this method allowed the blood to be filtered while the patient can carry out their own activities without needed to be stick at the dialysis machine over hours.

In peritoneal dialysis, blood is filtered inside the body after the abdomen is filled with a special cleaning solution. It means that blood is cleaned by using lining of abdominal area as a filter. This method allowed blood to be filtered while patient carry out their everyday activities.
Before first peritoneal dialysis session, doctor will create access to abdominal area by making small surgical cut, most often at the side of belly button. A plastic tube called a catheter is inserted into the stomach and nearby organ. This is called peritoneal cavity.

     HOW PERITONEAL DIALYSIS WORKS??

In peritoneal dialysis, peritoneum (natural lining of abdomen) acts as dialysis membrane. Small operation is needed to insert a catheter into the abdomen. The wastes and extra fluid are removed from the body into the lower bag when the dialysis solution is drained off. The fresh dialysis solution from the top bag is drained in into the peritoneal cavity. This is called an ‘exchange’- fresh fluid replacing old.

•    The draining and filling process, called an exchange take about 30 to 40 minutes. Patient will need 4 exchanges per day.
•       There are two main types of peritoneal dialysis:

a) Continuous Ambulatory Peritoneal Dialysis (CAPD).

This type of dialysis is done without a machine. Dialysis solution is placed into the catheter and patient can go for their everyday activities or sleep. It is done four or five times a day.

b) Continuous Cycler-assisted Peritoneal Dialysis (CCPD).

This type of dialysis uses a machine called a cycler to fill and drain the solution from the stomach, usually done while sleeping.

POTENTIAL PROBLEM THAT MAY ARISE DURING CAPD

•     Peritonitis- inflammation of peritonitis
•     Weight gain
•     Due to the use of dextrose solution and fluid overload in the body because of imbalance in and out fluid.
•     Dehydration
•      Due to drinking too little, causing too concentrated dextrose solution

HAEMODIALYSIS

Before we go in depth about hemodialysis, let we first explain to you what it is actually called dialysis. Dialysis is a life- saving treatment which is needed to replace over the kidney function when the kidney is unable to carry out it function anymore. Dialysis uses special machine to filter harmful wastes, salt and excess fluid from the blood. 

There are two types of kidney dialysis; Hemodialysis and Peritoneal dialysis. However, in this part we will only cover about hemodialysis.

 In hemodialysis, blood is filtered using dialyzer and dialysis machine. Before first session, doctor will create vascular access which is creating an entrance to into one of the blood vessels to connect to the dialysis machine.
 Vascular access can be done by:

•       Connecting an artery to a vein to create a larger blood vessel area, called a fistula

picture of graft

•          Joining (grafting) an artery and vein together using a soft plastic tube
•        Inserting a thin plastic tube into a large vein in the neck or groin area of the leg; this type of access is temporary. 

Access can be temporary or permanent dependent on individual condition. It is recommended to create the access weeks or months before using it so that it has enough time to heal properly.

HOW HEMODIALYSIS WORK??

Blood from the body (contains toxins and excess water) is pumped through a dialyser. then, a blood thinner called heparin is introduced into the blood to avoid clotting. The blood then passed into the dialysis fluid where it is filtered to remove the waste and excess water. The cleansed blood is then returned to the body while the waste is pumped away out of the dialyser

•  Patients have to attend the renal unit regularly 3 times a week, every week for haemodialysis.
•  It takes 3 to 5 hours each visit depends on how much toxic waste the individual patient makes. The bigger the patient, the more amount of toxic waste to be removed.

POTENTIAL PROBLEM THAT MAY ARISE DURING HEMODIALYSIS

•          Low blood pressure
•      Blood pressure fall due to rapid removing of fluid and salt. This can cause feelings of light- headed, sweaty and sick.

•   Nausea
• Occurs due to changes in blood in blood pressure during and after treatment

•    Cramp
•  Leg cramp may occur due to rapid removal of fluid during dialysis

•    Headache
•  Occasionally occurs at the end of dialysis due to changes in fluid and waste product level in the body