A friend wrote to me and asked me why the nurses and everyone in the renal team managing her mother insisted upon curfews upon curfews of dietary restrictions.She sadly told me her mum’s diet was tantamount to ash–bland.I really understand her concerns and those of many others.I partly blame this perception on lack of proper counseling and explanation on the disease process of chronic kidney disease.

Let us do some basics here and hopefully by the end we shall have understood why and what is allowed or not in renal patients.

Please note that I am talking from a perspective of Chronic kidney disease and not Acute kidney injury which we will discuss next week on #KidneyWednesday.

The kidneys have a role in eliminating a very important waste called urea from our body.Urea is usually as a result of protein metabolism.We normally have such a fine balance between the proteins we eat and what is in the bloodstream.This is because the kidneys maintain the harmony by excreting the excess urea in urine.

Now,when kidneys are no longer working,this metabolite accumulates in the bloodstream trying to escape.It sticks onto the skin and in a patient acutely ill you may see this as a few patches of whiteness on the face called uremic frost.It looks like the person has an unnaturally dry skin and it is quite itchy.

That is not all,too much urea clogs in the gut making the person have a severe case of diarrhea and or vomiting.If nothing is done,the urea will easily cross the protective membrane in the brain called the rain blood barrier.This will present as confusion,hallucination and such and you may wrongly diagnose the patient as being ‘crazy.’These are just some of the signs.Every system is affected differently by high levels of urea in the blood.

What we do therefore is eliminate as much sources of urea as possible.It is important for people to eat foods rich in proteins but our renal patients do so cautiously.Even then,special preparation of lentils,beans and such other plant-based proteins is called for.This is because the best protein is the one that has a high biological value.This is mainly white meet.Small portion is allowed ,approximately the size of one’s fist.

The problem is,our patients can barely manage to pay for the fare to attend the dialysis sessions.How do we expect them to afford chicken,rabbit and fish?

Pause and reflect.

That is why we end up guiding them on how to minimize the assault that plant-based proteins have on them.

The other culprit is Potassium.We need this electrolyte for many functions in our body.Most foods are rich in potassium.The body does not store potassium.It maintains a safe level again through kidneys function of elimination.Excess Potassium is excreted in urine.When there is a high level of potassium,the heart senses it very fast and this causes a cardiac arrest and death in most cases.

Potassium is found in bananas,pineapples,oranges and most green leafy vegetables.The Renal nutritionist advises total abhorrence of these fruits(and many other),as well as special preparation of green leafy vegetables.

Therefore we advise patients to boil first the vegetables,rinse out and fry without tomatoes because these again contain a good amount of potassium.

I know it looks bleak when I write this.It looks very unappetizing and downright grim.I wish it was different.Look,your kidneys and mine function 24 hours a day and 7 days a week around the four seasons of the year.Renal patients get to ‘clean their blood’ only twice a week.

How fair is that?What will happen if they have too much urea and too much potassium in their blood before the next dialysis session?

I know in the developed world the patients dialyse thrice a week but well,this is Kenya.

Thank you for passing by.

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