Membranous nephropathy dietary taboos

The core dietary taboos of membranous nephropathy are not as complicated as those reported on the Internet. To sum up, they are During the edema/massive proteinuria stage, strictly limit sodium, control total protein intake in stages, and avoid long-term large intake of high-fat and high-purine foods. For patients with renal insufficiency, additional potassium and phosphorus limits are required. During the stable stage, the standards can be appropriately relaxed. There is no need to completely abstain from common foods such as meat, eggs, and soy products. . Many patients are eager to give up all the "fat foods" when they are first diagnosed. On the contrary, they are prone to malnutrition and delay their recovery.

Last week, I just received a 32-year-old patient with second-stage membranous nephropathy. I am an Internet programmer. I just found out that the urine protein was 3+ and there was a hole in both lower limbs. I stopped eating all meat, eggs and milk when I went back. I drank white porridge with stir-fried cabbage every day. I came back for a checkup in half a month. The urine protein did not drop, but the plasma albumin dropped from 28g/L to 24g/L. It was so swollen that I couldn’t even wear shoes. To put it bluntly, it is a one-size-fits-all misunderstanding that "all kidney diseases require low protein".

Let’s first talk about the sodium control issue that is most easily overlooked. At present, the mainstream recommendations of domestic nephrology departments are that active patients with obvious edema and urinary protein greater than 3.5g/day should control their daily sodium intake within 3g, which is about the amount of a beer bottle cap. High-sodium foods such as pickles, processed meats, takeaways, and carbonated drinks should basically be avoided. Don’t underestimate the small plate of dried radish that you make porridge in the morning. The sodium quota for half a meal will be used up. However, in recent years, small-scale cohort studies in Europe and the United States have suggested that for patients who have been in continuous remission for more than 6 months, have no hypertension and edema, and have urinary protein quantification less than 0.3g/day, relaxing sodium intake to 4-5g will not increase the risk of recurrence. Don’t blame yourself for not even touching low-sodium soy sauce. There is no unified guideline on this point. You can make adjustments based on your own indicators and the recommendations of your attending doctor.

What is more likely to be pitted than sodium control is actually protein intake, which is currently the most controversial part in the field of nephrology. In the early years, the view was that all patients with kidney disease should be strictly low-protein, or even controlled to less than 0.6g/kg of body weight. However, the current mainstream evidence-based medical advice is to do it in stages: when there is a large amount of protein leakage during the active period, as long as it does not exceed the standard, high-quality protein will To eat enough, 0.8-1.0g/kg of body weight per day is just right. For a 60kg person, it is probably an egg + a box of 250ml pure milk + 2 taels of lean pork tenderloin, which is enough to maintain the body's albumin level and will not put additional burden on the kidneys. It used to be said that we should eat less plant protein, but now new research has confirmed that soy protein is also considered high-quality protein. As long as it is included in the total intake, it is perfectly fine to eat a piece of tofu and drink a bowl of soy milk occasionally. Some domestic traditional beliefs will recommend reducing the proportion of non-high-quality plant protein and giving priority to animal protein and soy protein isolate. Both views have their own evidence-based basis. There is no need to worry about whether you can drink half a cup of soy milk. I also met an aunt who heard that protein leakage must be replenished. She took two sea cucumbers and a bowl of bird's nest every day, and her urinary protein increased from 4g to 7g in half a month. This kind of "big supplement" would actually aggravate the urinary protein leakage, which is completely unnecessary.

Then there are high-fat and high-purine foods. Patients with membranous nephropathy are prone to lipid metabolism disorders. Patients taking hormones are more likely to have elevated blood lipids. Therefore, try to eat as little fat meat, animal offal, fried foods, and thick broths as possible during the active period. For patients in the stable period whose blood lipids have been completely normal and have been off medication for more than a year, it is okay to eat occasionally to satisfy their cravings. There is really no need to dare not even touch roasted pork with lipstick all year round. If the quality of life is too low, it will make you anxious, and it is not good for recovery.

By the way, if you already have elevated creatinine and your glomerular filtration rate is lower than 60ml/min·1.73m², you should pay extra attention to potassium and phosphorus control. Avoid using additives in concentrated fruit juices, dried fruits, and processed foods. Patients who are taking Sartan/Pullin drugs to lower urinary protein should not blindly supplement potassium. Just check blood potassium regularly to avoid the danger of elevated blood potassium. If your blood sugar is high while taking hormones, you should avoid refined sugar, and put milk tea and cakes away first.

In fact, I usually tell patients that there is really no need to count the grams from the food ingredient list, as long as you have the approximate number. During the edema period, eat lighter meals, eat less, and just eat enough meat, eggs, and milk every day. There is no need to deliberately eat more or less. I have seen too many patients who have strictly controlled their symptoms for more than half a year without getting a trace of oil or water. As a result, they went out to eat haphazardly and relapsed as soon as the reexamination was stable. Instead, it is better to relax a little as usual, satisfy their cravings occasionally, and let the water flow slowly. After all, when treating a disease, you have to take care of both the indicators and your days, right?