DISEASES OF THE KIDNEY: NEPHRITIS

DISEASES OF THE KIDNEY: NEPHRITIS
Acute glomerulonephritis (inflammation of the glomeruli) frequently follows a streptococcic infection of the respiratory tract or scarlet fever. It is seen most often in children or young adults. During the acute stage of the illness, there is nausea, vomiting, fever, hypertension, hematuria, and oliguria. The appetite is usually very poor and little is gained by forcing food when the gastrointestinal symptoms are present. The fluid intake is usually restricted. The fluid allowance may be taken in the form of fruit juices, fruit ices, ginger ale, sweetened weak tea, or high-carbohydrate low-electrolyte supplements. Even these small amounts of carbohydrate help to reduce tissue breakdown.
As soon as the patient is able to eat, a diet providing about 0.5 gm protein per kg for adults (up to 0.75 gm per kg for children) and sufficient calories to maintain weight is given. Most of the protein should be obtained from milk and eggs. Protein foods of low biologic value such as peas, Lima beans, dried peas and beans, nuts, peanut butter, and gelatin are omitted. Sodium restriction is not necessary except when edema is present. Potassium restriction is usually not required. Chronic glomerulonephritis may be present in a latent stage for years before symptoms are detected. When the kidney function is below 20 to 10 per cent of normal, the patient begins to complain of headache, fatigue, nocturia, and sometimes blurring of the vision. Hypertension, proteinuria and hematuria may also be present.
Sufficient nutrients to meet body requirements are of utmost importance so that the sense of well-being can be maintained as long as possible. Anemia is relatively common and persistent. Iron salts are usually prescribed, but they do not always correct the anemia.
If the blood urea is only moderately high, about 60 to 70 gm protein are included daily with particular emphasis upon sources of high biologic value. If there is proteinuria, the daily protein intake should be increased by the amount lost in the urine.
Sodium restriction is not necessary except when there is edema, but some physicians routinely prescribe mild restriction. Because the kidneys are unable to concentrate urine, the fluid and sodium losses can be high. Such losses must be corrected by adequate intakes of fluid and sodium. In these patients a sodium-restricted diet could lead to body loss of sodium, weakness, nausea, and shock.
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GENERAL HEALTH

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