Patient's question:
In July 2004, kidney syndrome was detected due to high blood pressure. Renal examination revealed mesangial proliferative glomerulonephritis. Treatment with prednisone and cyclophosphamide was administered. On April 25 of this year, prednisone was discontinued, and nocturnal proteinuria was negative (-), while daytime proteinuria was + or ++.Current general condition: Weakness in legs and feet, teeth marks on the tongue, yellowish-white tongue coating, night sweats.
Medical history: Hyperthyroidism.
Current medications: Tripterygium glycosides, Shen Kang Ning capsules, thiamine, and antihypertensive drugs.
Please kindly provide an answer from the expert during your busy schedule. Thank you.
Auxiliary tests: Liver and kidney function are normal, blood lipids, total protein, and albumin are normal, and blood routine is normal.
Doctor's answer:
★Nephrotic Syndrome is a group of stubborn conditions with significant clinical treatment challenges. It is not a single disease but a clinical syndrome caused by multiple etiologies, with the most fundamental characteristic being large amounts of protein in the urine. It is often accompanied by hypoalbuminemia, edema, and hyperlipidemia, collectively referred to as the "three highs and one low" symptoms in clinical practice.Treatment Methods: Due to its prolonged course, high recurrence rate, and complex pathological changes, the treatment of nephrotic syndrome is best approached through a combination of traditional Chinese and Western medicine. Western medicine primarily uses hormones to treat nephrotic syndrome, while traditional Chinese medicine can mitigate the side effects of hormones. The Red Special Road Outpatient Department of Nephrology at Henan University of Chinese Medicine Hospital has adopted a unique "Miraculous Herbal Bath Comprehensive Therapy." This integrated approach involves externally applying Huanyuan ointment to the Shenshu acupoints, internally administering traditional Chinese medicine preparations, and externally washing with herbal decoctions. This cross-sectional and three-dimensional comprehensive treatment has significantly improved the efficacy and cure rate of traditional Chinese medicine in treating chronic kidney diseases. The comprehensive therapy enhances the function of residual renal units, elevates the function of inhibited or underutilized renal units, and promotes the dissolution of proteases that cause kidney tissue fibrosis and, thereby markedly improving kidney function.
★Dietary Recommendations for Kidney Patients
1> What dietary restrictions do kidney patients have?
A reasonable diet plays a crucial role in the recovery of kidney diseases. What and how much should kidney patients eat? This cannot be answered in a single sentence. The dietary plan should be tailored to each individual based on the type of disease and the severity of the condition.
1. Can kidney patients consume salt and alkali? Normal adults consume about 5–6 grams of salt daily, while in some regions, daily salt intake can reach 12 grams per person. Salt is sodium chloride, alkali is sodium carbonate, and baking soda is sodium bicarbonate. Excessive intake of sodium-rich salt and alkali can lead to water retention in the body, triggering edema. Therefore, kidney patients with edema should control their salt and alkali intake, consuming no more than 2–3 grams of salt per day for a low-salt diet. A completely salt-free diet is not scientifically sound, as prolonged adherence can lead to fatigue and dizziness.
2. How much water should kidney patients drink? Normal urine output is typically 1–2 liters per day. During the oliguric phase of acute nephritis, acute kidney failure, nephrotic syndrome, and chronic kidney failure with oliguria and edema, fluid intake should be controlled. Excess fluid intake can worsen edema and high blood pressure. In such cases, daily fluid intake should be limited to urine output plus 500 milliliters. If urine output increases, fluid intake can be relaxed. Patients with normal urine output have no restrictions on fluid intake. Additionally, for patients with urinary tract infections such as acute pyelonephritis, urethritis, or cystitis, drinking plenty of water and urinating frequently is highly beneficial for recovery, in addition to timely medical treatment and medication.
3. Can kidney patients consume fish, shrimp, eggs, and meat? Some kidney patients may avoid these foods, believing they are harmful to the kidneys. However, these foods are high-quality protein sources. Patients with allergic conditions such as allergic purpura or purpura nephritis, or those with a history of fish or shrimp allergies, should use caution. Generally, these foods are not restricted. Fish, shrimp, eggs, and meat are rich in animal protein, which are essential for the construction of human cells and tissues. After consuming protein-rich foods, the liver breaks them down, and the kidneys excrete them. Therefore, when kidney function declines, protein intake should be appropriately reduced to meet metabolic and nutritional needs without overburdening the kidneys. Some patients may avoid protein due to mild kidney disease, or they may disregard protein restrictions when required by their condition—both approaches are incorrect.
4. Some kidney patients have long-term conditions with slow recovery, often discussing and sharing information and experiences. It should be noted that each person has unique characteristics, and imitation is not advisable.
5. Avoid overeating and consuming unhygienic foods.
2> Dietary Restrictions for Nephritis
1. Prefer light, easily digestible foods; avoid seafood, beef, mutton, spicy and irritating foods, alcohol, and all allergenic foods such as five-spice powder, coffee, and coriander. This is especially important for patients with yin deficiency, such as those with red tongues, large pulse volume, night sweats, dry stools, and hematuria. However, patients with yang deficiency, such as those with pale tongues, white coatings, deep pulses, cold limbs, loose stools, and body coldness, can consume warming foods.
2. Prefer fresh vegetables and moderate amounts of fruits; limit fluid intake. Avoid all tonics, supplements, and easily irritating foods such as chili peppers, lychees, and chocolate. This is particularly relevant for patients with yin deficiency and internal heat, such as those with purple tongues, stagnant pulses, chest tightness, and abdominal distension.
3. All kidney patients should avoid neomycin, streptomycin, gentamicin, Guanmutong, and autonomic immune injections.
4. Uremic patients should maintain regular bowel movements, with 2–3 bowel movements per day being ideal. Avoid staying up late, limit sexual activity, prioritize rest, and avoid exposure to cold.
5. Patients taking hormones should gradually reduce their dosage and frequency under the guidance of a physician.
6. Patients with severe edema should avoid salt, limit protein intake, and reduce fluid intake. For mild edema, a low-sodium diet is recommended. If there is no edema, fluid and protein intake are unrestricted. Patients with microscopic hematuria and those prone to heat should drink more water and consume nourishing, cooling foods such as apples, white sugar, black sesame, and black fungus.
7. Uremic patients with hyperkalemia should avoid high-potassium foods such as bananas, oranges, potatoes, tomatoes, pumpkin, tea, soy sauce, and MSG. Conversely, patients with hypokalemia should do the opposite.
8. Patients with high uric acid should avoid animal organs, fish, shrimp, crabs, clams, beer, mushrooms, beans, and spinach.
9. During treatment, if symptoms such as colds, fever, or infections appear, seek immediate consultation with a specialist to prevent complications from worsening.
3> Dietary Guidelines for Kidney Patients
1. Eat a light diet, avoiding alcohol and spicy foods, as well as greasy and high-protein foods such as fatty meat, shrimp, and crabs.
2. Avoid beans and bean products such as tofu, bean sprouts, and bean flour.
3. Patients with edema, high blood pressure, or heart failure should follow a low-salt or salt-free diet.
4. Patients with impaired kidney function or uremia should pay special attention:
① Avoid beans and bean products, and limit nuts (e.g., walnuts, chestnuts, almonds) and pickled foods (e.g., pickled vegetables, pickles).
② High-protein foods (e.g., lean meat, milk, eggs) should be consumed in controlled amounts. For most adults, this is about 2–3 ounces per day, divided into 3–5 meals.
③ In the end stage of kidney failure, the kidneys have limited water-excreting capacity, so fluid intake must be controlled. A formula is recommended: daily fluid intake = total urine output from the previous day + 500–800 milliliters.
④ To ensure the excretion of creatinine and urea nitrogen, bowel movements must be regular—preferably 2–3 times a day rather than every 2–3 days. Dandelion, watermelon, and gourd are diuretic. Red bean soup, black bean soup, mung bean soup, and sugar can promote diuresis and clear heat. Honey, bananas, pears, radishes, walnuts, and black sesame are laxative and can be used alongside medication for regular consumption.