| 特集名 | 腎疾患の栄養とその実際 | |
|---|---|---|
| 題名 | 慢性腎不全 | |
| 発刊年月 | 1999年 12月 | |
| 著者 | 加藤 明彦 | 新風会丸山病院内科 |
| 【 要旨 】 | 現在，慢性腎不全の進行を遅らせる治療は，蛋白制限と高血圧のコントロールが中心である．蛋白制限は尿毒症症状を軽減し，透析までの導入期間を遅らせる．さらに低蛋白食(0.6g/kg理想体重/day)では腎機能の悪化を遅らせる効果も期待される．蛋白制限を行う際にもっとも注意が必要なのはエネルギー不足である．エネルギー摂取目標は35kcal/kg理想体重/dayである．アルブミン，プレアルブミン，トランスフェリンなどの血液検査のみならず，3カ月に1回は体重測定および上腕筋周囲径を測定し，栄養状態をチェックする必要がある．蛋白制限を続けていくうえでもっとも重要なことは，蓄尿より蛋白摂取量を計算し，蛋白制限のコンプライアンスを患者本人にフィードバックすることである． 高血圧の管理はもっとも確実で，腎機能の進行を予防する可能性が高い方法である．降圧目標は蛋白排泄量が1g/day以上なら125/75mmHgとする．降圧薬は，アンギオテンシン変換酵素阻害薬あるいはカルシウム拮抗薬が有効である．また食塩摂取も1日6g以下に制限する必要がある． |
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| Theme | Practicing proper nutrition for kidney diseases | |
|---|---|---|
| Title | Management of protein intake and hypertention to prevent the development of end-stage renal failure | |
| Author | Akihiko Kato | Department of Internal Medicine, Maruyama Hospital |
| [ Summary ] | Protein restriction and blood pressure control are currently considered to be defective ways of preventing the progression of chronic renal failure. A protein-restricted diet can reduce the appearance of uremic symptoms and may also postpone need for dialysis by a year or more. Another possibility is that strict protein restriction (less than 0.6g/kg of ideal body weight/day) coulds low the rate of deterioration in renal failure. The most attentive point in maintaining a low protein diet is providing an adequate intake of food energy (at least 35 kcal/kg of ideal body weight/day). To prevent the onset of malnutrition, the nutritional status of the patient should be assessed by measuring serum parameters (albumin, prealbumin, transferrin), body weight and midarm muscle circumference every three months. The most important method for continuing protein-restricted diets is to provide patient feedback on the adequacy of protein intake, using an estimating formula with twenty four hour urine collection. The control of blood pressure is most consistently associated with protection from renal failure. The target blood pressure in patients with proteinuria of more than 1g/day is 125/75 mmHg. Several sudies demonstrated that angiotensin converting enzyme inhibitors as well as calcium channel blockers could afford long-term renal preservation. Sodium intake also needs to be restricted to within 6g/day. |
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