Health tips for patients with complex glomerular disease

What do you need to bear in mind if you have complex glomerular disease or you are caring for someone who does?

On the one hand, the function of the kidneys is to eliminate impurities from the body through the urine, and regulate the amount of liquid and chemical elements that we need, such as sodium, potassium, phosphorus or calcium.

On the other hand, the kidneys also help in regulating blood pressure by activating vitamin D, which is required to maintain healthy bones, and producing erythropoietin, which is required to produce red blood cells in the bone marrow.

When the kidneys do not work properly, the impurities we generate and the water that the kidneys cannot eliminate accumulates in the blood and the tissues, and this causes major disruptions to the patient’s general health, fluid retention and hypertension. They are also unable to properly get rid of some medications we take, which can accumulated in the body, increasing the risk of side effects.

As the kidneys are unable to help make vitamin D, or to retain phosphorous,  the bones are weakened. The kidneys are also unable to produce erythropoietin and therefore anaemia appears.

The main types of renal replacement therapy are:

• Haemodialysis
• Peritoneal dialysis
• Kidney transplant

Where patients will not benefit from renal replacement therapy, conservative treatment will be carried out, aimed at controlling the different disorders and symptoms that appear during evolution of the illness.

The majority of cases of glomerulonephritis cannot be prevented, although a healthy lifestyle is advised, as promoted by the Spanish National Health System:

• Keep glycaemia levels (blood sugar) and blood pressure within normal range.
• Avoid toxic habits
• Do moderate physical exercise
• Avoid obesity

In addition, the application of dietary and pharmacological measures can help prevent or decrease the progression of the illness:

Dietary measures that should be taken

Maintain a balanced diet and limit:

Salt

As substitutes, the following items can be used to eliminate or reduce consumption:

• Use vegetables as seasoning: celery, garlic, leek, onion, tomato, carrot.
• Add aromatic herbs and spices: if the herb is dry, it is better to add it towards the end of cooking, as this will make the most of its flavour.
• Flavour oil.

Potassium

Part of the potassium in food can be removed by:

• Water: once peeled and cut, soak foods. The longer foods are soaked for and the smaller the pieces, the more potassium will be lost. They can also be washed several times, changing water.
• Boiling: boiling foods removes potassium, as it stays in the water. You should therefore avoid consuming cooking water. It is better to change water after 10-15 minutes of boiling foods, adding clean boiling water.
• Frozen foods: frozen vegetables and legumes have less potassium than fresh ones, although they retain many of their other properties.
• Preserved food: when food is preserved in liquid, the potassium remains in the liquid and the food contains less. This liquid should be poured away.

Proteins

Although proteins are required for repairing and creating cells and tissues, as well as for the proper functioning of the immune system:

• Dried fruits and nuts are not recommended as they have a high potassium content.

Fluids

Fluid intake should be adjusted to each particular case:

• Reducing the sensation of thirst.
• Drinking only when thirsty and drinking small amounts.
• Not getting into the habit of drinking.
• Taking medication with the liquids in meals and using the smallest amount possible.
• Using citrus slices to stimulate salivation and moisten the mouth.
• Adding a few drops of vinegar to water.
• Chewing sugar-free gum.
• Adding a few drops of lemon juice to ice cubes before putting them in the freezer.
• Freezing fruit pieces.
• Reducing the intake of drinks such as coke, orange juice, etc., and replacing them with ice tea and homemade lemonade.
• Avoiding alcohol.

Pharmacological measures that should be taken

• Patients many need to take the same medications as patients undergoing dialysis. Some drugs may include:
  • Hypotensors: drugs to reduce blood pressure (angiotension converting enzyme [ACE] inhibitors or angiotension receptor blockers [ACB]).
  • Corticosteroids: better known as steroids, these are anti-inflammatory medications.
  • Immunosuppressants: drugs that inhibit the immune system.
• Medication that helps patients to alleviate the symptoms,  such as itching, pain, etc., may also be taken.
• Other measures may also be adopted, such as:
  • Avoid consuming nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Avoid contact with organic solvents and polluting substances, such as mercury.

Other related health information

• Looking after the peritoneal dialysis (PD) incision and catheter.
• Looking after a tunnelled central venous catheter (CVC)
• Looking after an arteriovenous fistula (AVF)
• Training and health education for patients and carers in PD treatment.
• Recommendations on discharge for patients with nephritic syndrome
• Advice for patients undergoing immunosuppressive therapy