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Copyright © 2014. KidneyDietSecrets.com

All rights reserved.

This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means – electronic, mechanical, recording, or otherwise – without prior written permission from the publisher, except for brief quotations embodied in critical articles and reviews, and testing and evaluation materials provided by the publisher to instructors who have adopted its contents.

This is NOT a free book. Hence, you do not have any right to resell it. If you purchased this book from anywhere else other than KidneyDietSecrets.com, please report that site to: support@kidneydiets.com . Thank you.

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Disclaimer

The author of this book is not a medical doctor. Rather, she is a wife, a mother, and a nurse who devoted the past eight years of her life seeking for treatment options especially for patients who cannot or simply do not have financial resources to succumb to dialysis and transplantation. This book is based on a series of discoveries made by researchers worldwide, coupled with the author's own learning experiences as far as managing kidney patients is concerned. This book is also rooted from the theoretical expertise of other manuscripts, journals, scientific papers, and medical reports, which the author deliberately consulted to support her claims and dissertations.

This book is not intended to provide medical advice or diagnose illness. Furthermore, it is not intended, in any way, to replace medical care from a licensed health care practitioner. It is merely designed to promote awareness to its readers, specifically regarding the birth of something which the author calls 'kidney diet tips' – tips which were once but are now secrets no more.

It is of the readers' discretion whether or not to follow the contents of this book. While this text contains a universally certified body of knowledge, it still does not guarantee a hundred percent effectiveness ratio. After all, things work in an individualized basis... and this is a philosophy which the author keeps on reiterating throughout the book.

The author is forced to include this disclaimer due to the litigious nature of today's world, which may give rise to expected attacks, criticisms, and attempts to suppress and discredit this work.

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Contents

Copyright Notice …................................................................................................................................. i

Disclaimer …............................................................................................................................................. ii

Preface ….................................................................................................................................................... iv

Excerpt …................................................................................................................................................... v

Difference Between NKF and Kidney Diet Secrets...................................................................vi

Chapter 1: ...Got a Kidney Disease? YOU are not alone. …..................................................... 9

Chapter 2: A Close Encounter with Mr. Bean …........................................................................ 11

Chapter 3: The Main Culprits of Kidney Disease .................................................................... 17

Chapter 4: Mr. Bean's Warning Hints …....................................................................................... 21

Chapter 5: Treatment Options for your Kidneys …................................................................ 24

Chapter 6: Dietary Recommendations for Patients on Dialysis …................................... 35

Chapter 7: Dietary Tips for Kidney Disease Patients …....................................................... 40

Chapter 8: Adequately Low-Protein Diet to Delay Dialysis and Transplantation …. 52

The 25g/day Protein Workbook …................................................................................................ 57

Serving Sizes of High Protein Foods …........................................................................................ 60

Serving Sizes of Medium and Low Protein Foods ….............................................................. 62

References …........................................................................................................................................... 65

Recipes......................................................................................................................................................66

Appetizers and Snacks...........................................................................................................74

Breakfasts....................................................................................................................................88

Soups and Salads.....................................................................................................................96

Meat, Chicken and Seafood Entrees............................................................................108

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Rice, Pasta, Stuffing............................................................................................................132

Vegetables..............................................................................................................................140

Breads......................................................................................................................................147

Desserts...................................................................................................................................154

Disclaimer...............................................................................................................................174

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Preface

Dear Reader,

I took care of you from the day you were born. I worked all day and night for you. I fought all odds that came along to harm you... simply because I sincerely love you.

You were then so young, happy, and free... and I couldn't help but smile while catching a glimpse of you. You taught me to live and love selflessly. In return, I gave you myself wholeheartedly.

...but now, I just can't do it anymore... because I'm all too weak to do the same thing. All my life, I've devoted myself to you. Yet, you showed me no reciprocation at all.

You know I didn't ask for anything else but love. You deprived me from it and it was your choice. In silence, I cried you rivers of tears... hoping that one day you'll realize my worth.

Now, I'm dying and I still love you no less. Trust me!!! I still do what it takes to protect you. ...but this I say “I need you more than ever”... and if you care enough to help me live, please... please... do your part.

Sincerely, Your Kidneys

With the relevance of the growing statistics of renal-impaired patients, this book unfolds a secret rarely untold. It highlights a multitude of kidney diet tips, all of which can delay the need for dialysis and transplantation.

Besides the main gist of the text, this book retells the kidney anatomy and physiology story. It proceeds by identifying and defining a series of kidney disorders, then introduces the latter's causes and manifestations.

Before formally giving justice to the title of the text, “Kidney Diet Secrets Revealed: A Dialysis and Transplantation-Free Approach” also offers bonus topics for enhancement. These include the prevention of and treatment options for diseased kidneys among a few. In addition, it weighs the advantages and disadvantages of the latter, so as to help patients aid their physicians make more educated decisions as far as their treatment is concerned. By the way, this book is presented in a very simplified yet informative manner, hence making it worth reading.

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Excerpt

Prior to the release of this book in the market, the author did a random survey amongst kidney patients. She did a soft distribution of the gist of her text to the first 50 renal clients who mailed her two years ago(as per instruction from the author's personal site). Out of the 50 strangers who eventually became her friends, 37 mailed back while 9 sent her fresh flowers as a note of thanks. Among the most remarkable lines gathered from the author's mail are as follows:

“Brilliant! I never I thought I could manage my kidney disease until your book

came. Thank you!” -John Callahan; Stockton, California

“I knew it!!! It was your book all along. It was such a sweet miracle for me. I hope it can touch more people's lives. - Sydney Carolls; Denver, Colorado

“You should keep up this good work, Rachelle. It inspires people... it inspired

me.” - Seth Johnson; Phoenix, Arizona

“I know I won't be the only one who will write to you in thanksgiving. Your book worked wonders. It really did.” - Jimmy Bricks; Boise, Idaho

“Tried and tested!!! Simply amazing!!!” - Dwight Robinson; Salem, Oregon

“Rachelle, everyone in our family is grateful to you. Of course, I'm the one who

is most thankful.” - Carl Thomas; Phoenix, Arizona

“I thought I would be in dialysis for the rest of my life. I was so afraid then you came. You are a living legend, Rachelle. I hope you continue writing and researching. You're the best!!! ” - Stephanie Swank; Austin, Texas

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Difference Between National

Kidney Foundation's Protein Intake and Kidney Diet Secrets

The main difference between National Kidney Foundation's dietary recommendations and the Kidney Diet Secrets lies within the fact that we have dealt into each and every component of your diet especially protein which is the most crucial of them all.

By following the “Kidney Diet Secrets”, you will be able to save hundreds and even thousands of dollars from repeated doctor and dietitian visits. Though we urge each and every one to consult with doctors at the start of any treatments, this will eventually save you time and money down the road.

The National Kidney Foundation does not specify a definite protein intake limitations. Further, they require you to see your doctor AGAIN only to be referred to a dietitian. Here's a portion of their brochure distributed regarding protein

intake:

“You may feel a bit confused by all the new information about your kidney disease and its treatment. You probably have many questions about your diet. Help is available to you. Your doctor can refer you to a registered dietitian with special training in kidney disease. This dietitian can answer your questions about your diet and can help you plan your meals to get the right foods in the right amounts.”

The “Kidney Diet Secrets” guide bypasses this step (along with a lot more) by recommending a maximum of 25g of protein per day. This is the most crucial part of this book as you will soon see.

As you go through the guide, you will be able to know everything that a kidney patient or caregiver has to know and will never feel you are uninformed that most patients feel.

Page 50-57 of this book summarizes everything so you will be able to effectively manage your kidney disease starting immediately.

Please be guided accordingly.

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Chapter 1

Got a Kidney Disease?

YOU are not alone.

The Problem

Kidney disease, otherwise known as nephropathy, has always been an underrated phenomena. Considering its growing prevalence in diverse parts of the world, it is indeed a subject of great importance.

No matter how acute or chronic it may be, kidney disease is definitely something to look out for. Since it affects the young and old alike, it is a predicament which we should never be complacent about.

While it is true that kidney disease is a frequent complication of diabetes, there are many other causes to it. In fact, there are still those which are left undiscovered, while there are those which are deemed far beyond what the human intellect can ever expect. This only means that it is imperative for us humans to continuously learn and observe ways concerning proper care of our kidneys.

The height of massive kidney destruction due to genetics, underlying medical diagnoses, and unhealthy lifestyle has paved way for a wide array of nephropathies to evolve worldwide. Indeed, its significantly increasing number of reported and unreported cases over the past millennia has made it impossible for statistics to perfectly quantify its prevalence.

It cannot be denied that stigma play a substantial factor as far as unreported kidney pathologies are concerned. What seems to be a human notion of fearing how their relationship with other people might be affected by their illness is sheer trepidation from within.

Kidney disease, otherwise known as nephropathy, has always been an underrated phenomena. Nevertheless, a fact remains that kidney disease can be treated. The earlier you know that you have it, the better. Why risk putting stigma in

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mind? Who knows? By admitting that you have it and by fighting against it, the life you'll end up saving... could be yours.

Magnitude of the Problem

Kidney disease has become a societal tumor especially in the United States. Suffice to say, it has been neglected and allowed to spread in various sectors of the community, hence leading to what it is now—a societal cancer.

Kidney disease is more common among Hispanics, African Americans, Asians, Pacific Islanders, and Native Americans. It is 40% more prevalent among citizens over 60 years of age. Nonetheless, it can also show itself to people as young as 20, which only means that we are all at risk of acquiring this seemingly painstaking dilemma.

According to an online medical encyclopedia which was last updated in the year 2007, acute renal failure affects approximately 3 among 10,000 hospitalized people. To date, almost 80 million Americans are actually experiencing this condition, making it one of the leading causes of financial burden amongst the Western citizenry.

Meanwhile, statistics show that the prevalence of chronic kidney disease has increased by up to 25% from the previous decade. Specifically, it has been made known to the public that approximately 20 million Americans are suffering from the aforementioned condition. This, according to researchers, is attributed to the growing incidence of diabetes mellitus, hypertension, and obesity, which I will be elaborating in the third chapter.

It is sad to note that overall, renal disease affects 6 out of 10 Americans. In California alone, over 500,000 are already inflicted by some form of nephropathy. This, I believe, is a bittersweet reality, considering the fact that kidney disease can be prevented in the first place. Making this ugly truth sound even worse is the result of the 2009 worldwide statistical survey that 13 people are added every minute to the transplant waiting list, while 18 die everyday waiting for a suitable donor organ. To top it all, about 67,000 people expire each year because of kidney failure.

Before I officially end this chapter, allow me to ask you one question. “...got a kidney disease???” To this, I say: “YOU are definitely not alone!!!”

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Chapter 2 A Close Encounter

with Mr. Bean

When I was still in grade school, I could vividly remember interchanging kidneys with liver and vice versa. The aforementioned thought embarrassed me, considering the fact that the said organs are too basic to bring even the slightest confusion. It wasn’t until my anatomy and physiology class in nursing school that I found out I wasn’t the only one going through such obscurity. Surprisingly, almost all of my classmates started out like me as well. At least, I didn't have to go through the embarrassment of raising an all-time basic question in class.

Fortunately, such mix-up is common so it was intervened relatively early. In fact, I could still remember how my instructor used to incorporate the famous character Mr. Bean to help me and my classmates get rid of such phenomena. Since then, I started associating the human kidneys to Mr. Bean, until such time when I have already proven to myself that I have mastered the craft of distinguishing the kidneys and the liver in a human cadaver. Yes, we studied real dead bodies... and Mr. Bean helped me a lot, considering that the human kidney is bean-shaped in itself.

When I started having my clinical exposures in line with the course medicalsurgical nursing years ago, I also had trouble explaining to my patients whenever they ask me how kidneys work. I used to throw in some medical jargons every now and then... but again, I finally managed the aforementioned dilemma – not with the help of Mr. Bean this time, but through constant reading and intensive fact-finding.

Throughout this chapter, join me as we altogether unfold important matters about Mr. Bean. I choose to incorporate this seemingly basic segment because I suppose we could better understand kidney disease if we know the fundamentals of the said body organ.

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Anatomy

As mentioned, the kidney is a bean-shaped structure located at each side of the retroperitoneal cavity. It extends from the T12 to the L3 vertebra, thus it receives some protection from the lower part of the rib cage. Due to the anatomical placement of the liver, the right kidney is positioned slightly lower than the left (illustrated in Figure 2.1), hence giving it a more convenient stance as it performs its somatic functions.

Figure 2.1: Anatomical Landmark of the Human Kidney

An adult kidney is about 12 cm (5 inches) long, 6 cm (2.5 inches) wide, and 3 cm (1 inch) thick, about the size of a large bar of soap. It is convex laterally and has a medial indentation called hilus – a vital section where several structures including the ureters, renal blood vessels, and nerves enter or exit the kidney. Atop each kidney is an adrenal gland, which is part of the endocrine system and is a distinctly separate organ functionally. Each adult kidney weighs between 125 and 170 grams in males and between 115 and 155 grams in females.

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The tissue portion of the kidney consists of two principal layers: the outer layer called the renal cortex and the inner layer called the renal medulla (shown in Figure 2.2). The tissue of the cortex and most of the medulla is composed of subunits called nephrons, which science now regards as the structural and functional units of the kidney.

Figure 2.2: Representation of the Human Kidney and its Parts

Blood is supplied to each kidney through a usually single renal artery that divides into several branches from within. As the renal artery approaches the hilus, it divides into segmental arteries. Once inside the pelvis, the segmental arteries break up into lobar arteries, each of which gives off several branches called interlobar arteries. At the medulla-cortex junction, interlobar arteries give off the arcuate arteries, which curve over the medullary pyramids. Small interlobular arteries then branch off the arcuate arteries and run outward to supply the cortex tissue. Venous blood draining from the kidney flows through veins that trace the pathway of the arterial supply but in a reverse direction – interlobular veins to arcuate veins to interlobar veins to the renal vein, which emerges from the kidney hilus itself.

Physiology

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The major function of the kidney is the formation of urine. Urine formation serves four principal roles. First, it eliminates waste products of body metabolism together with many drugs. Second, it stabilizes the plasma's content of sodium, chloride, potassium, calcium, magnesium, and phosphate ions. Third, it maintains control over the body's acid-base balance. Lastly, it regulates the volume of blood plasma and tissue fluids by controlling the excretion of water.

The kidney also plays vital roles in other body activities. It influences the formation of red blood cells, stimulates the synthesis of some steroids, helps regulate blood pressure, controls bone growth by converting Vitamin D into its biologically active forms, and affects many of the substances involved in metabolism.

Based on what is presented in the previous paragraphs, it can be implied that the human kidney is indeed physiologically competent. Miniature as it is, it is capable of performing a series of complicated tasks simultaneously. Nevertheless, how are all these things made possible?

Each kidney is connected to the urinary bladder by mini pipes or tubes called the ureters. This simply means that from the kidneys, urine travels down the bladder via these 8 to 10-inch long structures. The aforementioned activity is facilitated by the muscles in the ureter walls, which constantly tighten and relax to force urine away from the kidneys, following what we call downward motion or motion of gravity. Subsequently, urine is stored in the bladder until it reaches a certain limit. When this happens, nerves from the bladder signal the brain, hence giving rise to the intensification of what we call the urge to void.

Collectively, both kidneys process about 200 liters of blood and produce approximately 2 liters of urine on a daily basis. With the aid of urine itself, each kidney is able to remove accumulated waste products and excess fluids generated in the human body.

When there is loss of blood or deficiency of oxygen in the blood, the kidneys respond by liberating into the bloodstream increased amounts of the hormone erythropoietin, which stimulates the bone marrow to increase its production of red blood cells (erythrocytes).

Meanwhile, in some states of stress, when excessive amounts of fluids are lost from the body or when blood pressure starts to fall, the kidneys release the enzyme renin into the blood where it reacts with another protein to produce angiotensin. Angiotensin acts as a potent stimulator of the adrenal glands to secrete the steroids aldosterone and corticosterone. In addition to this, angiotensin invigorates the

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muscular walls of its targeted arteries and arterioles, and excites all elements of the sympathetic nervous system, particularly those which are involved in preventing blood pressure from falling.

Tagged as the body's master chef, both kidneys work in sync in regulating electrolyte homeostasis. With this in mind, it is imperative to assume that patients with renal disorders commonly experience fluid and electrolyte imbalance. Hence, they require careful assessment and close monitoring for signs of potential problems.

Disruption in Homeostasis

Like other body organs, the human kidney can malfunction, creating a homeostatic nightmare in the body. We humans are largely aware of this, yet we still choose to succumb ourselves towards the precipitating factors of the said dilemma. This is indeed sad to note, yet this is reality – a kind of reality which all of us can actually attest.

What are the most common conditions which arise from disruption in kidney homeostasis? Allow me to lay them before you in alphabetical order.

• Acute Renal Failure: This occurs when there is rapid loss of glomerular filtration and tubular function. It is usually associated with low urine volume, along with flank pain to name a few.

• Chronic Renal Failure: CRF is a condition used to denote progressive loss of renal function over a period of months or years. The symptoms of worsening kidney function are unspecific, and might include feeling generally unwell as well as experiencing reduced appetite.

• End-Stage Renal Disease: ESRD refers to the condition in which the kidneys can no longer properly filter bodily wastes. From the name itself, it occurs when chronic renal failure has worsened to the point at which kidney function is less than 10% of its normal.

• Glomerulonephritis: Glomerulonephritis is a generic term which means inflammation of the glomeruli (the capillary structures that filter wastes from the blood). This usually occurs as a result of an autoimmune reaction to infection in the body. Symptoms include retention of fluids with swelling, particularly in the hands and facial area.

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• Hypernephroma: Hypernephroma is a form of renal cancer that originates in the lining of the proximal convoluted tubule, the very small tubes in the kidney that filter the blood and remove waste products. The classic triad of the aforementioned condition include hematuria (blood in the urine), flank pain, and abdominal mass.

• Nephrosis: This is a term which pertains to kidney damage caused by factors other than kidney infection or blockage. Nephrosis can result from diabetes, hypertension, tumors, or autoimmune reactions to various chronic diseases. It is the leading cause of end-stage renal disease in the year 2007.

• Nephrotic Syndrome: Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein into the urine. It is also marked by hypoalbuminemia and edema.

• Polycystic Kidney Disease: PKD is an hereditary condition characterized by the appearance of numerous cysts in the kidneys. It is slow in progression and may show few symptoms until damage has become extensive and renal failure has begun.

• Pyelonephritis: Otherwise known as kidney infection, this is often due to accumulated obstructions in the urinary tract, hence causing urine to pool in the kidneys. Manifestations of pyelonephritis are as follows: fever with chills, nausea, and tenderness in the kidney area.

• Renal Calculi: More popularly termed as renal stones, renal calculi are small, hard deposits of mineral and acid salts on the inner surfaces of the kidneys. They usually form in the kidney pelvis, although they sometimes pass through the ureter to the bladder. Symptoms include extreme pain in the back or in the colon area.

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Chapter 3

The Main Culprits

of Kidney Disease

Acquainting oneself with issues concerning kidney disease is a matter of great importance. Nonetheless, knowing and understanding the fundamentals of the aforementioned dilemma is even more noteworthy. I am saying this out of concern, because in the past decade, the onset of kidney disease has risen like a nightmare.

Causes

Believe it or not, we tend to overlook the causes of a certain pathology. Whenever we encounter a disease or two, we are too obsessed with the thought of curing the latter to the extent that it is the only thing that concerns us. While this is good, we should also remember that finding out what causes this particular disease is an aspect which we should never forget to include in our assessment. If you ask me why, this is simply because knowing where a phenomena stems from enables us to anticipate what to avoid so as to prevent its recurrence in the future.

As mentioned, the onset of kidney disease has risen like a nightmare... and I wonder why statistics continually report a significant rise in its prevalence up to this date. Do we not know the causes of kidney disease??? ...or do we know but we just don't care at all???

a. Genetics: Some diseases in the kidneys are caused by genetic mutations. Examples of these include Polycystic Kidney Disease (briefly described in the previous chapter), Von Lippel Lindau Syndrome (a renal carcinoma), and Fabry Disease (an x-linked disorder brought about by a deficiency of the alpha galactosidase A enzyme).

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b. Hypertension: Elevated blood pressure (>140/90mmHg) makes the heart work harder, thereby causing undue stress to blood vessels throughout the body. If the blood vessels in the kidneys are damaged, they said organ may stop removing wastes and extra fluid. These extra fluid, in turn, may raise the blood pressure even more.

c. Diabetes Mellitus: Diabetes is the number 1 cause of kidney failure. It initiates the kidneys to start overworking by attempting to filter out excess sugar. Over time, the small blood vessels in the kidneys become damaged. Scar-like materials build up on the capillary walls where most of the filtering process occur. As a result, wastes continue to build in the body while other valuable substances are passed in the urine. When the kidneys stop cleaning the blood of wastes, renal failure occurs.

d. Heart Disease: Most heart diseases generate complications that inhibit proper kidney functioning. Heart disease and kidney disease are intertwined, which only means that either can exist as a consequence of the other. Another thing, when the presence of one is identified, it should be anticipated that the second is coming up very soon.

e. Others: Other notable causes of kidney disease whose relationship to the latter are still under continuous scrutiny include long term use of analgesics, HIV infection, sickle cell disease, heroin abuse, amyloidosis, chronic kidney infections, and certain cancers.

Obesity and Kidney Disease

It must have come to your surprise why I separated obesity from the leading causes of kidney disease as listed above. I purposely did this, because up to this date, the liaison between both parties is not well-established. While statistics show that more incidences of kidney disease crop up among obese people, no explanation has directly linked the two as far as health science is concerned.

Despite the fact that no direct relationship exists between obesity and kidney disease, the former is still recognized as one of the leading forerunners of the latter. Considering the fact that obesity acts as one of the chief precipitating factors in acquiring the other causes of kidney disease such as hypertension and diabetes mellitus, it cannot be discounted that the aforementioned condition is still something which we should fervently watch out for.

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In addition, obesity can cause practical problems especially for people on dialysis. Overweight patients with fat arms can have certain problems with access for hemodialysis, while those with distended abdomen can have application dilemmas as far as peritoneal dialysis is concerned.

Overweight patients should instantly refer themselves to a dietitian for advice. Most likely, they should be placed in a high protein, low sodium, low potassium, and low phosphorus diet to minimize complications.

Prevention

It's quite funny to think why we can't save ourselves from the risk of acquiring kidney disease when in fact, it is preventable in the first place. Yes, genetics may be something which we can never escape from, but intensive researches show that kidney disease is more closely linked to a series of underlying pathological concerns. This only means that kidney disease prevention is more significantly associated to the avoidance of acquiring its causative dilemmas.

Browsing through books and journals about the causes of kidney disease, namely: hypertension, diabetes mellitus, and heart disease, it can be noted that the aforementioned conditions are considerably lifestyle-acquired. Hence, there is only one secret to kidney disease prevention after all; that is, managing a healthy lifestyle.

Below, I will be presenting a roster of health promotion activities which at the same time serve as kidney disease prevention tips. These are basically selfexplanatory in nature, so I hope you understand why I won't mind the thought of elaborating it anymore.

Kidney Disease Prevention Tip #1: Know your blood pressure and keep it under control.

Kidney Disease Prevention Tip #2: Exercise regularly.

Kidney Disease Prevention Tip #3: Avoid smoking.

Kidney Disease Prevention Tip #4: Know your cholesterol and triglyceride levels.

Kidney Disease Prevention Tip #5: Consume a balanced diet.

Kidney Disease Prevention Tip #6: Maintain a healthy weight.

Kidney Disease Prevention Tip #7: Avoid excessive alcohol ingestion.

Kidney Disease Prevention Tip #8: Minimize stress.

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Kidney Disease Prevention Tip #9: Reduce your salt and fat intake.

Kidney Disease Prevention Tip #10: Visit your physician regularly.

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Chapter 4

Mr. Bean's Warning

Hints

Manifestations

I suppose I have already given you an overview on the most common signs and symptoms of kidney disease. If you wish for a proof, you can browse through it at the end part of Chapter 2. Having said the aforementioned statement, it could have been possible to omit this chapter. However, a second thought occurred to me. Wouldn't it be better to have these manifestations presented in bullet form? In this manner, it would be easier for us to remember such warnings. Of course, I will also be expounding terms for the purpose of knowledge supplementation.

Listed underneath are some warning signs that you might have observed by now. Although these manifestations do not instantly confirm the presence of kidney disease, they should not be discounted upon. General as it may seem, these signs may indicate other pathological dilemmas. Hence, it is but safe to consult a physican whenever any of these manifestations occur.

A. Subjectively and Objectively Perceived Manifestations

• Abdominal Mass: Kidney cancer can sometimes cause a mass in the abdomen. It may indicate an enlarged kidney, and may develop in the periumbilical (around the navel) or epigastric (center of the abdomen just below the ribcage) region.

• Edema: Edema is a medical term which is used to connote swelling of body tissues. It forms in patients with kidney disease for two reasons: (1) a heavy loss of protein in the urine, or (2) impaired renal function. If a patient cannot remove a ring from his finger anymore, he has an upper extremity edema. If his slippers don't fit as they usually do, he has what we call lower extremity edema. Abdominal swelling is called ascites.

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Meanwhile, generalized swelling is called anasarca.

• Flank Pain: Pain caused by the kidneys is typically felt in the flank area. The word 'flank' refers to the back, just at the lower edge of the ribs on either side of the spine. Pain tends to be sharp and severe. It usually occurs in waves.

• Nocturia: Nocturia is described as the uncontrollable urge to void excessively during sleeping hours. It may only be a mild irritation to some; for others, it can make it virtually impossible for them to obtain a restful sleep.

• Oliguria: Oliguria is defined as “urine output that is less than 1 mL/kg/h in infants, less than 0.5 mL/kg/h in children, and less than 400 mL/d in adults”. It is one of the clinical hallmarks of renal failure, and has been used as a criterion in diagnosing and staging the latter.

• Urinary Retention: Urinary retention is the abnormal holding of urine in the bladder. Acute urinary retention is the sudden inability to urinate, hence triggering the onset of pain and discomfort. Causes can include urinary obstruction, stress, or neurologic problems. Meanwhile, chronic urinary retention refers to the persistent presence of urine left in the bladder after incomplete emptying. Common causes of chronic urinary retention are bladder muscle failure, nerve damage, or urinary tract obstruction.

B. Vital Sign - Based Manifestations

• Fever: Fever is a classic sign of kidney infection. It is usually an early sign of renal disease and may indicate the presence of either of the following: (1) glomerulonephritis, or (2) pyelonephritis.

• Hypertension/High Blood Pressure: The universally accepted normal blood pressure of a healthy individual is 120/80 mmHg (millimeters mercury). Having reached three consecutive readings of at least 140/90 mmHg taken after a 10-minute rest in three successive days, a person is clinically classified as hypertensive.

C. Diagnostically Perceived Manifestations

• Blood Urea Nitrogen (BUN) Levels beyond Normal Range: Blood urea nitrogen is a waste product that builds up in the blood when kidney function is reduced. Its normal value ranges from 0.6-1.2 mg/dL.

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• Elevated Creatinine Count: Creatinine is a by-product of body metabolism and muscular activity. As the kidneys become impaired for any reason, the creatinine level in the blood will rise due to poor renal clearance.

• Glomerular Filtration Rate (GFR) less than 60 mL/min/173m2: GFR is a measure of kidney function. In fact, it is used to classify the severity of kidney damage, with 60 mL/min/173m2 indicating a borderline low standard measure.

• Hematuria: Hematuria is a medical term for “presence of blood in the urine”. If kidney distress is going on, this is a common warning sign. It may be a marker of kidney infection, stone, or cancer.

• Proteinuria: Literally, the aforementioned term is translated as “protein in the urine”. It often results from diabetes, high blood pressure, and diseases that cause inflammation in the kidneys.

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Chapter 5

Treatment Options

for Your Kidneys

The kidneys perform a series of tasks which are unique to that of the other somatic organs. As tackled above, it serves as the body's master chef considering the fact that it regulates fluid and electrolyte homeostasis. In addition to the aforementioned statement, the kidneys play a vital role in nutrient waste and drug excretion, hence preventing a phenomena called intoxication.

Nephrologists estimate kidney function via a series of blood and urine tests. As mentioned, among the most important components for diagnostic analyses include the following, namely: GFR (glomurular filtration rate), creatinine, bilirubin, red blood cells, and protein. Any form of disparity in whichever of the said test is a medical emergency.

In creatinine, for instance, it should not be discounted that a value below 40 warrants an urgent professional consultation. Before it reaches 30, treatment options are expected to be finalized because the latter simply indicates the fact that kidney damage is imminent.

From chapters 1 to 4, I have already featured most of the salient points about kidney disease. Having discussed its definition, prevalence, causes, and manifestations among a few, I suppose what's left for me to tackle now is the management of the said dilemma. This, I deem, should not be left behind, because it is through the latter that restoration of health is made possible.

The two major treatment options for kidney failure are dialysis and transplantation. While the former has two kinds of procedures, namely: hemodialysis (accessed via IV route) and peritoneal dialysis (performed via the abdomen), the latter, on the other hand, involves a multitude of complex pre-operative and postoperative interventions.

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It is helpful to note that each treatment option has its own pros and cons which need to weighed carefully according to medical diagnosis and personal preference. Nevertheless, it is still but necessary to follow specific guidelines given by the physician regardless of the alternative taken.

Why do I need to study about the invasive treatment options of kidney disease when the main goal of this book is to introduce kidney diet tips?

This e-book is actually intended to guide you through pre-dialysis and pretransplantation treatment as enriched by the synchronized effort of adequately-low protein diet and vitamin supplementation.

I coin the term 'kidney diet tips' to address the aforementioned revelations because of their breakthrough accomplishments in the new millennia. It is indeed uplifting to note that a seemingly life-shattering dilemma such as kidney disease is now being successfully managed by something as fundamental as proper diet.

The success of kidney diet tips has been backed up by countless research studies from different parts of the globe, most especially in the United States and United Kingdom as well. It has been proven that these so-called diet tips delay progression of renal disease. In fact, thousands of patients have already testified to this claim.

Considering the fact that kidney diet tips merely work as a precursor to invasive treatment options, I am therefore still obliged to discuss the latter with you. This, I believe is for your own good, because if worse comes to worse, you will still need to undergo dialysis or kidney transplantation in spite of everything. After all, setting aside the goal of this book, our overriding target is geared towards treatment individualization (that is, following a case-to-case basis) and health restoration above anything else.

As a health care provider, my only wish is to see to it that I am able to impart you with as much knowledge about kidney disease as I can. This, for me, includes the concept on dialysis and kidney transplantation, because I believe that these treatment options can help us better manage kidney disease as necessary. Trust me!!! You will be a notch higher than most kidney disease patients by knowing everything that I included in this book.

I highly suggest you to go through this section because you will definitely learn a multitude of valuable information which you could not find elsewhere. The rest of

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this book is written using a nursing perspective. Rest assured, it is going to be presented in the easiest way possible.

Hemodialysis

Hemodialysis is a method used to remove waste products such as creatinine and urea, as well as free water from the blood when the kidneys are failing. It works with the aid of a massive machine and a specialized filter called a dialyzer. It is done regularly, usually 3 times a week.

During hemodialysis, blood is taken from the body through an access, and then made to pass through a machine via soft tubings (shown in Figure 5.1). This cycle is done multiple times, allotting a duration of 3 to 5 hours per session.

Hemodialysis can either be an inpatient or outpatient therapy. Dialysis treatments in a clinic (inpatient dialysis) are initiated and managed by specialized staff made up of nurses and technicians. Meanwhile, dialysis treatments at home (outpatient dialysis) can be self initiated and is managed or done jointly with the assistance of a trained helper who is usually a family member.

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Figure 5.1: The Hemodialysis Cycle

Needle Insertion Techniques

Most hemodialysis sessions require needle insertion. Most dialysis centers use two needles—one to carry blood to the dialyzer and the other one to return the cleansed blood to your body. Some specialized needles are designed with two openings for two-way blood flow. Nevertheless, these needles are less efficient.

Some people prefer to insert their own needles, which require training on infection control and vascular access protection. Regardless of whether you opt to be trained or not, you should still learn the two key strategies of needle insertion which I have presented below.

(1) The Ladder Strategy: This is a needle insertion technique wherein you “climb” the needle up following the entire length of the

28

fistula session by session, so as not to weaken a body part with a group of needle sticks.

(2) The Buttonhole Strategy: This is a needle insertion technique wherein you use a limited number of sites by inserting the needle precisely into the same hole made by the previous needle stick.

Venous Access Devices

Venous access devices are mechanical gadgets used to connect the bloodstream to the dialysis machine. Over the last 3 decades, improvements have been made to make these devices more efficient and less invasive, thus making infection an unlikely outcome.

There are currently 3 ways in which an access can be made. Here they are as arranged from the most to the least widely used.

• Fistula (illustrated in Figure 5.2)

• Graft (illustrated in Figure 5.3)

• Catheter (illustrated in Figure 5.4)

A fistula is an artificial connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathological process, such as trauma or erosion of an arterial aneurysm. A fistula is created by sewing together an artery and a vein, usually utilizing the vessels above or below the elbow.

Figure 5.2: A Cross-Sectional View of an AV Fistula

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A graft is much like a fistula in most respects, except that an artificial vessel is used to join the artery and the vein in the former. Grafts are usually made of a synthetic material, often PTFE (polytetrafluoroethylene) – a component present in pans and other cookware. They are inserted when the patient's native vasculature do not permit a fistula, and are only used as a second choice to the latter most of the time. Since they mature faster than fistulas, they may be ready for use several weeks after formation. However, they are at high risk to develop narrowing, especially in the vein just downstream from where the graft has been sewn. Hence, they predispose their patients to clotting, thrombosis, and infection pretty easily.

Figure 5.3: A Replica of an Arteriovenous Graft

A catheter is usually inserted in temporary cases (e.g. if a graft or fistula has not healed yet). Nevertheless, it can be made permanent if both access lines are not viable. It is the least effective of the three. Furthermore, it comes with the most susceptibility to infections and blood clots so it is generally not used under normal circumstances.

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Figure 5.4: A Photograph of a Hemodialysis Catheter

Advantages and Disadvantages of Venous Access Devices

The following segment intends to guide you through the process of selecting the best venous access device as necessary. Considering the fact that it is essential to weigh the pros and cons of every alternative preprocedurally, you are now way ahead of the other kidney failure patients with the information given. Just make sure you make the best out of this and I guarantee that you will be able to make a certified informed decision.

A. Fistula

I. Pros

• Longer lasting

• Least susceptible to infection

• Provides an excellent blood flow to the body once healed

• Not easily traumatized

• Least vulnerable to blood clot development

• Waterproof

II. Cons

• Necessitates a longer healing stage

• Might need catheter for temporary access

• Requires painful needle puncture upon application

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B. Graft

I. Pros

• Provides an excellent blood flow to the body once healed

• Not easily traumatized

• Waterproof

• Only necessitates a 2-week healing period

II. Cons

• Not suitable for long term use

• More susceptible to infection as compared to that of a fistula

• Vulnerable to clot formation if used in a long-term basis

• Requires painful needle puncture upon application C. Catheter

I. Pros

• Can be used immediately after insertion

• Does not necessitate needle puncture upon application

II. Cons

• Usually for temporary access only

• Most susceptible to infection

• Does not offer as much blood flow as needed

• Most prone to blood clots

• Non-waterproof

Care for Hemodialysis Access Sites

Protecting the dialysis access is very important for a number of reasons. First, infection is very much possible as all of the access sites are invasive. Second, the cost that is involved in another minor surgery can be a burden to your already expensive treatment options. Lastly, you have limited number of veins that offer enough blood flow for exchanges. Hence, you might want to observe hemodialysis guidelines before its too late.

• Check access sites several times each day to make sure that the latter is functioning.

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• Monitor site for any signs of bleeding after dialysis. If the graft seems to bleed longer than it usually does, you should notify your dialysis center staff.

• Do not carry heavy items with the arm that has the access.

• Do not sleep on the aforementioned arm.

• Do not wear any clothing or jewelry on the affected arm.

• Do not let anyone draw blood or measure blood pressure from that particular arm used in dialysis.

• Do not allow injections to be given into the fistula or graft.

• Keep the site of the fistula or graft clean.

• Monitor the access site for signs of infection such as swelling or redness post dialysis.

• Do not use any form of creams and lotions over the site of the fistula or graft.

Peritoneal Dialysis

Peritoneal dialysis is a treatment mode used for patients with severe chronic renal failure. The process uses the patient's peritoneum (the serous membrane that forms the lining of the abdominal cavity) as a membrane across which fluids and dissolved substances (elctrolytes, urea, glucose, and albumin) are exchanged from the blood.

In peritoneal dialysis, a sterile solution containing minerals and glucose is run through a tube into the peritoneal cavity, where the peritoneal membrane acts as a semipermeable jacket (shown in Figure 5.5). Fluid is introduced through a permanent tube in the abdomen and flushed out either every night while the patient sleeps (automatic peritoneal dialysis) or via regular exchanges throughout the day (continuous ambulatory peritoneal dialysis). It is used as an alternative to hemodialysis, though it is far less common.

In peritoneal dialysis, the dialysate is left in the abdomen for a period of time to absorb waste products, before it is drained out through the tube and discarded. This cycle or "exchange" is normally repeated 4-5 times during the day, (more often overnight via an automated system).

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Figure 5.5: The Peritoneal Dialysis Cycle

Peritoneal dialysis is less efficient than hemodialysis, but because it is carried out for a longer period of time, its net effect in terms of removal of waste products (e.g salt and water) is similar to that of the latter.

Yes, peritoneal dialysis is carried out at home by the patient. Although support is helpful, it is not essential. It can free patients from the routine of having to go to a dialysis clinic on a fixed schedule multiple times per week, and it can be done while traveling with the aid of a specialized equipment.

Kidney Transplantation

Basically, kidney transplantation is a major operation done to patients who have renal failure. It is a process wherein a patient receives a kidney from a donor who may be dead or alive. Donors may come from a friend or a complete stranger, and are only classified as such after organ compatibility has been guaranteed by a series of laboratory examinations.

Benefits

Kidney transplantation has come a long way since it was first performed more than half a century ago. Once a favorite subject of numerous researches, surveys, and further studies, advancements in medical technology have

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already made kidney transplantation easier for both physicians and patients nowadays.

Rejection

No matter how minor, all surgeries entail a degree of risk that doctors repeatedly miss telling their clients about. As a health care provider, I always see to it that I inform my patients what they need to know about the latter, because I believe that this is a fundamental nursing responsibility.

The most common complication as far as kidney transplantation is concerned is rejection. This happens when the body labels a newly installed kidney as a foreign matter, and starts to raise an attack against the latter.

To better understand rejection, think of kidney transplantation itself as a territorial battle. If a king (your brain) gets notified by the messenger (your flowing blood) that a certain foreigner (the new kidney) is occupying a part of his kingdom (your body), he (your brain) would normally summon a military assault. He would then launch a series of attacks by sending in various types of armies in constant succession, until such time when he thinks he has swept the colonizer (the new kidney) away. Hence, rejection occurs.

Prognosis

Despite the number and severity of risks involved, kidney transplantation still offers its patients with the best treatment outcome possible... most especially if the latter is performed successfully. In fact, surveys indicate that patients who have fruitfully underwent the latter live a better and more fulfilling life than those who stick with dialysis.

Patients who undergo kidney transplantation have 90% chances of survival at least for the next 2-3 years. This we attribute to the height of modern technology, particularly to the birth of new medications.

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Chapter 6

Dietary

Recommendations

for Patients on

Dialysis

In the previous chapter, we have discussed that although hemodialysis acts by artificially doing some of the work of your kidneys, it still cannot replace the natural function of the aforementioned body organ. Being placed on dialysis only means that you are going through some renal dilemma. Hence, you need to carefully regulate your diet.

This chapter aims to present the most suitable diet for dialysis patients with the help of certified highly-acclaimed researches. Read through this informative text with me as I bring to you a series of dietary guidelines which I believe could help you somehow.

Diet

Following the prescribed dietary regimen for dialysis is important because the aforementioned procedure does not effectively remove ALL waste products in the body. In fact, these so-called toxins even build up between treatment sessions.

Most dialysis patients urinate very little or none at all. Therefore, fluid restriction between treatment sessions is equally important. We all know that in the absence of micturition, fluids surge in the body. It consequently lodges in the heart, lungs, and extremities among a few, thereby causing a condition known as edema.

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Protein

Protein is an essential nutrient that enables the body to build muscles and repair itself. It also helps the latter in fighting infection. Main sources of protein in our diet include meat, fish, dairy products, eggs, and vegetables such as peas, beans, and lentils.

Low-protein diets may prevent or slow the progress of some kinds of kidney disease. Although the amount of protein you can eat is based on how well your kidneys are functioning, it is also vital to take into consideration how much protein your body needs to maintain good health.

The amount of protein allowed in your diet is determined by checking the amount of protein and protein waste by-products in your blood. The universally suggested amount of protein in a low-protein diet is 0.6g/kg/day. Although our adequately-low-protein diet would suggest otherwise, it is still vital to know the basis of our dieticians.

Nevertheless, extremely low levels of protein can lead to malnutrition and fluid retention if left unattended. It can also lessen our body's ability to fight infections.

Whenever proteins are used up by the body, waste products such as urea are formed in the bloodstream. Normally, healthy kidneys are good at getting rid of these wastes. Nonetheless, although failing kidneys prove otherwise, renal patients should still eat protein.

It is very important for you to follow your dietitian's advice regarding your protein intake. Before dialysis, you may be asked to limit protein to slow the progression of kidney disease. However, you will need much more of it at the start of dialysis. Patients on peritoneal dialysis need even more protein, because a large amount of the latter can be lost in the peritoneal fluid that is discarded.

Sodium

When talking about sodium (or salt in general), it is very helpful to remember that water is ALWAYS attracted to the latter. Suffice to say, they endlessly go together. This means that in patients who have swelling or edema, it goes without saying that you need to limit your sodium intake so that water will not accumulate in your body and further increase the latter.

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Furthermore, hemodialysis patients often have greater restrictions on fluid intake than peritoneal dialysis patients. Hence, it is imperative to note that hemodialysis patients need to be more careful about their salt intake than peritoneal dialysis patients.

Potassium

Hemodialysis patients need to avoid potassium-rich foods such as chocolate. At the same time, they are expected to limit intake of potassiumrich fruits such as bananas. Meanwhile, peritoneal dialysis patients are luckier, since they rarely need to restrict the latter. Hence, they are allowed to consume potassium-rich

foods, provided that they do so moderately.

Phosphate and Calcium

Phosphate and calcium affect the health of the human bones. When a person has kidney failure, the calcium levels in his body tend to be too low and the phosphate levels the opposite way around.

Phosphorus is not effectively removed by dialysis treatments, so you need to reduce your intake of dairy products and other foods high in phosphorus. If dietary measures to lower phosphorus are not enough, "phosphorus binders" may be recommended by your dietician. These medications bind the phosphorus in your food, hence making them unavailable to your body.

Fluids

When you have kidney failure, the amount of urine your body produces may decrease. Hence, you need to reduce fluid intake as well, so as to prevent it from excessively building up in the body.

During kidney failure, urine output usually stops completely once patients have been on hemodialysis for more than 6 months. Hence, strict fluid restriction is a cardinal rule amongst hemodialysis patients. On the other hand, patients on peritoneal dialysis usually have fewer restrictions on fluid. This is simply because the aforementioned patients undergo dialysis treatments everyday.

Vitamins

There are two classes of vitamins, namely: fat soluble and water soluble vitamins. Fat-soluble vitamins such as Vitamin D may be supplemented, depending on the patient's calcium, phosphorus, and parathyroid hormone

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levels. Meanwhile, water-soluble vitamins are lost during dialysis treatments. This means that all dialysis patients should receive water-soluble vitamin supplements on a daily basis.

Water soluble vitamins do not build up in the body and must be replaced through diet. Chronic kidney disease patients have greater requirements as far as the latter is concerned. Others

People with kidney disease are more prone to heart disease. Hence, they often need to follow a low-fat diet.

Calcium is already given in the dialysis solution and is adjusted according to individual blood calcium levels. Specifically, it should be taken 1000 to 1500 milligrams per day. Iron supplementation, on the other hand, is usually monitored every 3 months to determine amount as needed by the patient. Since most dialysis patients do not get enough iron, they must receive the latter through a vein during dialysis sessions. Magnesium supplement is not needed, though.

Dietary Guidelines

The following are some general guidelines that you should follow at all times, before or after dialysis has started:

• Eat regular meals.

• Include a variety of nutritious cuisines in your diet.

• Consume fiber-rich foods such as whole-grain bread and cereals.

• Limit your fat and salt intake.

To reduce your weight:

• Eat foods which contain less fat. Fat is extremely rich in calories.

• Minimize your sugar intake. Sugar has no nutritional value other than

calories.

• Lessen your alcohol consumption. Even moderate amounts of alcohol provide lots of calories.

To reduce your fat intake:

• Avoid cake, pastry, cream, mayonnaise, cream cheese, and other high fat

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sources.

• Use butter or margarine sparingly. Try low-fat spreads.

• Cut the fat off meat.

• Use skimmed or semi-skimmed milk in place of full cream milk.

Loss of appetite is one of the classic signs of kidney failure. Together with weight loss, this is an important reason for starting dialysis. Hence, if you have a poor appetite and if you are losing muscle mass or flesh weight, you may find the following tips helpful.

• See your dietitian to help you in terms of diet modification.

• Eat small frequent meals.

• Eat snacks which have nutritional value.

• Boost your calories. Add butter or margarine to cooked vegetables and use full cream instead of low fat milk.

Recommended Dietary Allowance Modifications

Kidney disease may change your need for some basic nutrients over time. This is made possible by the following facts which I have synthesized and listed subsequently.

• When you have kidney disease, there are certain substances which your kidneys cannot manufacture anymore.

• Sometimes, you may not feel well enough to eat a healthy diet. It only means that you do not get enough vitamins and minerals everyday.

• The poisons that build up in your body each day can change the way the latter uses assimilated vitamins and minerals.

• Following a chronic kidney disease diet means missing certain vitamins and minerals from some food groups.

• Dialysis causes certain vitamins to be lost during treatment.

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Chapter 7

Dietary Tips for

Kidney Disease

Patients

Throughout the past decade, the National Kidney Foundation has been releasing leaflets aiming to inform people on how to prevent further kidney damage among patients with renal diseases. Being a recipient of the aforementioned brochure, I commend the foundation for making such a strategic move... and I could say that they have incorporated much of the information we need about kidney disease. Perhaps one notable thing they fail to give in those pamphlets are dietary tips which I believe people greatly need to know. Nevertheless, I don't blame them. After all, those “dietary tips” which I have been talking about were once secrets just recently unfolded.

Yes, I'm referring to “dietary tips” which have been reliably tried and tested in different parts of the globe for a couple of years now. Once a part of clinical trials, these dietary tips are now proven and certified for its groundbreaking success. Considering the fact that the aforementioned tips delay the progression of renal disease, they have earned praises from critics all over the world.

It is not anymore a medical secret that your diet can make or break your kidneys. Nevertheless, it shows that further political action will have to be taken for the authorities to acknowledge this fact. Hence, it is my earnest hope that in one way or another, this e-book would raise that effort even in its simplest form – by teaching more people about holistic kidney care.

In this chapter, we are going to deal with dietary tips, particularly for patients with nephrotic syndrome, acute renal failure, chronic renal failure, and renal calculi. Yes, these dietary tips are secrets no more. In fact, they're yours.

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Nephrotic Syndrome

Nephrotic syndrome is a term used to describe a series of symptoms that can occur as a result of damage to the tiniest blood vessels of the glomerulus. It often transpires as a result of secondary insult to the kidneys such as glumerulonephritis, amyloidosis (a disease of abnormal accumulation of waxy starchlike component of protein which affects kidney functioning), some infectious diseases, and diabetic mellitus.

The aforementioned damages can show itself in your urine. Among its classic manifestations are proteinuria, decreased serum albumin levels, increased level of fats in the blood, and edema or swelling of the extremities.

In cases such as nephrotic syndrome, the physician would normally put a patient on a medication regimen that involves lowering his immune resistance as a therapeutic intervention. In some patients, nephrotic syndrome is resistant to medications and will eventually progress to chronic renal failure.

Dietary Tips

Primary goals of diet and nutrition therapy for nephrotic syndrome patients include minimizing swelling, controlling hypertension, decreasing albumin losses in the urine, preventing protein malnutrition, supplying enough food for energy consumption, and ultimately suppressing progression of renal disease.

When you have nephrotic syndrome, you need to take in sufficient amounts of protein (0.7 to 1.0 g/kg/day) as well as enough calories (35 kcal/kg/day) for energy consumption and malnutrition prevention. For example, if you are a 70 kilogram adult, you need as much as 49-70 grams of protein per day (70 x .7 and 70 x 1.0). In addition, you have to make sure that you are taking in 2450 kilocalories (kcals) to provide your body with enough energy to supply its needs.

Carbohydrates are also essential in nephrotic syndrome, as it helps you provide energy for daily consumption. Good sources of carbs include bread, rice, and pasta among a few.

In nephrotic syndrome, certain limitations are imposed on fat, salt, and fluid intake. As a matter of fact, the amount of the aforementioned nutrients in the body should not exceed 30% of your daily energy needs.

What to Avoid

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(1) Sodium-Rich Products

• baking powder

• mouthwash

• toothpaste

• medications ◦ Antacids

◦ Antibiotics

◦ Cough Medications

◦ Laxatives

◦ Pain Relievers

◦ Sedatives

(2) Sodium-rich

Foods• Condiments

◦ pickles

◦ olives (black and green)

◦ salted nuts

◦ meat tenderizers

◦ commercial salad dressings

◦ monosodium glutamate (MSG)

◦ steak sauce

◦ ketchup

◦ soy sauce

◦ worcestershire sauce

◦ horseradish sauce

◦ chili sauce

◦ commercial mustard

◦ seasoned salts (onion, garlic, celery)

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◦ butter salt

• Breads/Starches

◦ potato chips

◦ salted crackers

◦ corn chips

◦ popcorn

◦ pretzels

◦ dehydrated potatoes

• Meats/Meat Substitutes

◦ smoked meats

◦ cured meats

◦ processed meats

◦ ham

◦ bacon

◦ corned beef

◦ chipped beef

◦ hot dogs

◦ luncheon meats

◦ bologna

◦ salt pork

◦ canned salmon

◦ canned tuna

◦ cheese (except low-sodium and cottage cheese)

◦ convenience store foods (microwavable dinners)

◦ peanut butter

• Beverages

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◦ instant hot cocoa mixes

◦ commercial butter milk

• Soups

◦ dehydrated soups

◦ canned soups

◦ bouillion

• Vegetables

◦ hominy

◦ sauerkraut

◦ pork and beans

◦ canned tomato

◦ vegetable juices

Acute Renal Failure

Acute renal failure is accompanied by an immediate loss of kidney function that may or may not have decreased urine output. The most common cause of acute renal failure is acute tubular necrosis or ATN. It is most commonly described as post-ischemic (after a decreased rate of blood flow to the kidneys) or nephrotoxic (poisoning of the organ).

ARF naturally follows a three-stage sequence. These are identified as follows:

(1) Oliguric Phase

- usually present within 24-48 hours after an organ injury

- lasts for 1-3 weeks

- shows the following clinical signs, namely: azotemia, acidosis, high serum potassium, high serum phosphorus, hypertension, anorexia, edema, and risk of water intoxication.

(2) Diuretic Phase

- usually lasts for 2-3 weeks

- demonstrates pronounced increase in urine output

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(3) Recovery Phase

- characterized by gradual improvement in kidney function

- may show signs of permanent damage

- usually lasts for 3-12 months

Dietary Tips

Nutritional needs of ARF patients are determined by its cause and treatment. There are generalized dietary variations in patients who have trauma or infection-acquired ARF as compared to those who have diseaseacquired ones.

Enough energy (usually 30-40 kcal/kg of body weight) should be provided for patients with acute renal failure to be able to meet the demands of stress accompanying the aforementioned disease condition. Fats, oils and simple carbohydrates, as well as low protein starches should provide nonprotein kilocalories.

In cases where dialysis is not a treatment option, protein should be regulated to 0.6 grams per kilogram body weight. While this is a wellaccepted value, it is imperative to note that protein should not exceed more than 40 grams on any person.

During the oliguric phase of the disease, sodium might be restricted up to 1000-2000 mg and potassium to 1000 mg per day. Nevertheless, they are of utmost necessity during the diuretic phase of the disease, considering the fact that these electrolytes are lost via micturition. The same principle goes with water.

What to Consider (depending on the phase of ARF)

(1) Potassium-rich Foods

• apricots

• avocados

• bananas

• cantaloupes

• carrots

• dried beans and peas

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• dried fruits

• melons

• oranges, orange Juice

• peanuts

• potatoes (white and sweet)

• prune juice

• spinach

• swiss chard

• tomatoes

• tomato Juice

• tomato sauce

• winter squash

Chronic Renal Failure

Chronic renal failure results from a progressive, irreversible loss of kidney function. It is generally a disease that slowly develops over months and years depending on the insult done to the kidneys as well as on the extent of that particular damage.

CRF has many causes, namely: glumerolunephritis, nephrosclerosis, kidney stones, birth defects, diabetes mellitus and systemic lupus erythematosus. As identified in Chapter 2, excessive analgesic use has now been tagged as a contributory cause to CRF as well.

It is vital to prevent progression of any kidney disease to chronic renal failure as the latter would eventually lead to end-stage renal disease (ESRD). From the name itself, ESRD is the stage which most Americans with kidney disease fear most.

It is our goal to delay progression of chronic kidney disease. We can do this, of course, simply by having adequately-low protein diet and vitamin supplementation as mentioned in the Chapter 5.

Dietary Tips

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Nutritional management in CRF patients is highly individualized. It is largely dependent on the the latter's treatment method, medical condition, and nutritional status among a few.

A. Dietary Pointers for CRF Patients who are not yet on ESRD

Treatment Modality: diet and medications

Expected Duration: indefinite

Possible Concerns to Anticipate:

• hypertension

• diabetes mellitus

• glomerular hyperfiltration

• rise in BUN levels

• bone disease

• anemia

• cardiovascular disease Nutritional Guidelines:

Energy = >35 kcal/kg of ideal body weight

Protein = 0.6-1.0 g/kg ideal body weight

Fats = depending on severity of risk factors

Sodium = 1-3 gm/d

Potassium = depending on laboratory result

Phosphorus = 8-12 mg/kg ideal body weight Calcium

= approximately 1000-1500 mg/d.

Fluids = as desired

Vitamin/Mineral Supplementation = as appropriate

B. Dietary Pointers for CRF Patients on HemodialysisTreatment

Modality: diet, medications, and hemodialysis Frequency and

Duration: 3 sessions per wk, 3-4 hrs every session Possible

Concerns to Anticipate:

• bone disease

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• hypertension

• interdialytic fluid and electrolyte changes

• anemia

• cardiovascular disease Nutritional Guidelines:

Energy = 30-35 kcal/kg ideal body weight

Protein = 1.1-1.4 g/kg ideal body weight

Fats = depending on severity of risk factors

Sodium = 1-3 gm/d

Potassium = approximately 40 mg/kg ideal body weight

Phosphorus = approximately < 17 mg/kg ideal body weight

Calcium = approximately 1000-1500 mg/d.

Fluids = 500-1000 ml + urine output/d

Vitamin/Mineral Supplementation = as appropriate

C. Dietary Pointers for CRF Patients on Peritoneal

DialysisTreatment Modality: diet, medications, and dialysis

Frequency and Duration: 7 days every week, 3-5 exchanges

Possible Concerns to Anticipate:

• bone disease

• weight gain

• hyperlipidemia

• glycemic control for DM patients

• anemia

• cardiovascular disease Nutritional Guidelines:

Energy = 25-35 kcal/kg ideal body weight

Protein = 1.2 – 1.3 g/kg ideal body weight

Fats = depending on severity of risk factors

Sodium = 2-4 g/d

Potassium = depending on laboratory result

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Phosphorus = approximately <17 mg/kg ideal body weight

Calcium = approximately 1000-1500 mg/d

Fluids = unrestricted if weight and blood pressure is controlled and residual renal function is 2-3 L/d Vitamin/Mineral Supplementation = as appropriate

Renal Calculi

Renal calculi, also known as kidney stones or urolithiasis, is a common and recurrent condition that affects more men than women. It is so recurrent to the point that half of the patients affected will develop another bout of the said dilemma in the next 10 years.

Most commonly, calculi are composed of calcium oxalate (70-80%), uric acid (10%), struvite (9-17%), or cystine (<1%). Its most classic signs and symptoms include low urine output, high urine pH (making it alkaline), and excessive urinary excretion of the aforementioned components (calcium oxalate, uric acid, struvite, and cystine). Nevertheless, although calcium is the most prevalent cause of renal calculi, dietary intake of calcium bears no significant effect in stone formation.

The type and cause of stone formation provide details on how to manage renal calculi. A comprehensive dietary history taking might also be needed to be able to point out the portion of the patient's diet that triggered the formation of the latter. Generally, treatment options include restrictive diet modifications as well as medications.

Conventionally, the presence of too much calcium in the urine is the main cause of kidney stones. It accounts for more than 70% of the latter's total occurrence. While formation mechanisms vary, some factors are present in most cases. These include drugs, medical conditions, and dietary factors. Dietary Tips

• Tailor diet to specific metabolic disturbances and individual dietary habits to ensure compliance.

• Calcium restriction should be avoided.

• Calcium and oxalate levels must be in its balanced state.

• Limit intake of spinach, rhubarb, beets, nuts, chocolate, team wheat bran, and strawberries.

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• Do not exceed recommended daily allowance for vitamin C as it increases urinary oxalate excretion.

• Animal protein should be regulated to 1 g/kg body weight.

• Salt intake should be restricted to less than 100 mEq/dl.

• Potassium intake (five or more servings of fruits and vegetables each day) should be encouraged.

• Include high fluid intake (2-3 L of water intake/day is recommended) to produce at least 2 liters of urine/day.

Prevention Tips for Calculi Formation (The Dietary Aspect)

(1) Fluids

Drink fluids... and I mean a whole lot of them. Simple water has been proven and tested to be the best bet against calculi formation. Its alternatives include lemon-lime softdrinks, ginger ale, and fruit juices.

The fact remains that you need to expel 2.5 quarts or urine per day to prevent kidney stone formation. To do this, you need to drink 10-12 quarts of water. If you live in a hot climate, you may need to increase that amount to 16 quarts. In that way, your body won't run out of water stores.

(2) Calcium

Do not restrict your dietary calcium unless instructed by your health care provider. Lowering your calcium intake will ultimately lead to more disease conditions such as osteoporosis. It may also increase your risk of acquiring oxalic acid stones.

(3) Sodium

Use fresh or frozen vegetables when possible. If you are cooking for the family, use only half the salt that the recipe requires. Trust me!!! The whole family will benefit from this... based from my own experience.

(4) Protein

Keep your protein intake at a moderate level, because too much of it is deemed harmful as well. A maximum of 6 oz of protein (on a healthy individual) already gives the body enough energy during the day.

(5) Oxalates

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Limit intake of foods rich in oxalates. Examples of this include rhubarb, spinach, soy burger patty, beetroot, almond, tofu, pecans, peanuts, okra, chocolate, collard greens, and sweet potatoes.

(6) Potassium

Increased potassium intake significantly lowers the risk of kidney stone development. Hence, potassium rich foods such as fruits and vegetables are essential in the diet.

(7) Carbohydrates

Increase intake of complex carbohydrates such as whole grains, fresh fruits, and vegetables. In this way, your body will have enough energy as you face a day full of activities.

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Chapter 8

Adequately Low-Protein Diet

to Delay Dialysis

and Transplantation

In order for us to do even the simplest of tasks, we need energy. To get this energy to keep us going, we eat food... we drink water... we breathe air. Collectively, food, water, and air make up a huge factor in determining how well we fare in our ADLs (activities of daily living). Hence, they should not be taken for granted.

While food is a basic need and choosing what to eat is a right, we should also remember that eating the right kind of food is a must. With the wide array of diseases afflicting our world today, it is but indispensable to be careful in choosing what to eat considering the fact that diet is regarded as a precipitating factor in the disruption of the health continuum.

Choosing the right kind of food to eat does not only benefit those who are illfree. It also aspires to help those who are under par. For instance, in kidney disease, it has been deemed that consuming an adequately low-protein diet delays the need for dialysis and transplantation.

This chapter focuses on the importance and benefits of adequately low-protein diet amongst kidney patients. Read on to grasp the gist of the text.

Macronutrients

Before I even begin dealing with the concept of protein, I believe it is essential for you to understand what it truly is. Hence, allow me to render a very brief discussion on macronutrients along with protein's two other macronutrient counterparts – carbohydrates and fats.

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We all know that macronutrients are nutrients which are required in relatively large quantities. They function to provide energy in terms of calories, and have three broad classes, that is, carbohydrates, fats, and of course, protein.

Carbohydrates

There are two basic types of carbohydrates, namely: simple carbohydrates such as glucose and sucrose, and complex carbohydrates, which include starch and dietary fiber. Each type of carbohydrate serves distinct roles in nourishing the body.

Carbohydrates provide energy, fiber, and naturally occurring sweeteners. They have two major roles as enumerated below.

• They are the primary source of energy for the brain.

• They serve as a source of calories to maintain body weight.

If enough carbohydrates are taken to supply the energy needs of the body, protein can be spared. A diet containing optimum level of carbohydrates can also help prevent body fat accumulation.

Fats

Physical health is maintained by consuming dietary fats which are necessary for essential fatty acids, energy, and fat-soluble vitamins. Besides the aforementioned functions, fats protect the internal body organs.

Fats are the slowest source of energy but the most energy-efficient form of food. Each gram of fat supplies the body with about 9 calories, more than twice the amount of energy supplied by the two other macronutrients. Since fats are efficient forms of energy, they are stored by the body either in the abdomen (omental fat) or under the skin (subcutaneous fat). They are intended for use when the body needs more vigor than usual.

Proteins

In the last century, having a high standard of living is symbolized by the ability of a family to serve chicken meat in each meal... but times have changed since then. Now we know that proteins can be taken from plant sources such as legumes, rice, and beans.

If you haven't been watching your protein intake since you had your kidney disease, there is a good chance that you have been adding insult to your condition. This is the main reason why we focus our discussion on protein intake regulation.

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How does a patient with kidney failure keep off from H & T (hemodialysis and transplantation)? The answer to the aforementioned question can be taken historically. In 1869, it so happened that a brilliant nephrology pioneer by the name of LS Beale noted: “A large proportion of the excess of meat taken during meals pass off from the body in the form of urea and other urinary constituents, which it is the special work of the kidney to remove from the blood. It is obviously of utmost importance to relieve the kidneys of at least this unnecessary and useless function in cases of diseased state, when their working power is seriously impaired.”

Way back 1869, little organized knowledge is understood about the works of the kidneys. He claimed that increased meat intake puts too much stress on the kidneys that it works to the point of getting weaker and weaker as the years pass. Logically, it follows that he advised low protein intake to get stress out of the kidney's workload.

Strange enough, quantifying protein intake and classifying the latter as low or high seemed hard back then. It was not until a few decades after that health professionals took the effort of quantifying protein intake for renal patients.

Today, with the advancement of nephrology, we now have quantifiable values to serve as references. We now know that an average American takes in approximately 40g of protein per day.

Nevertheless, nephrologists still look at figures differently. If you have been “doctor shopping” or at least have tried taking second opinions from doctors other than your own, you will definitely notice certain variations as far as “low protein diet” is concerned. This is simply because researches show that protein intake necessitates individualization for best results. However, given the notion that specialists do have different opinions regarding protein values, one significant unanimous fact remains – Low protein diet works well amongst renal patients.

For most patients, the thought of giving up protein in the diet is dreadful. So, if you are thinking about the same thing, its perfectly normal. Now, if you worry much about this, perhaps it would be soothing to think about the fact that you will spare your family from the added burden of you going to dialysis clinics twice a week and the pain of seeing you undergo an invasive kidney transplantation surgery with the aid of your “low-protein diet” sacrifice. Now... do you feel better???

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Adequately-Low Protein Diet

An adequately-low protein diet consists of taking at most 25g of protein per day. (Later in this text, I have provided you with a workbook which you can use to accurately measure your protein intake. The latter also aims to help you manage your diet.)

How To Start on an Adequately-Low Protein Diet

If you ask any specialist, they would advise you to seek for a dietitian's assistance. I would not deviate from this rule. In fact, having handled countless kidney patients as a nurse, I have observed that indeed, patients who seek advise from dietitians have better outcomes than those who don't.

By experience, I can attest its effectiveness in two reasons. One: You will be able to take in foods that best suit your diet. Two: You will be able to come up with a diet plan that is based on the foods that you love. In the first place, who said you cannot enjoy your favorite foods?

The Amino Acid Effect

Amino acids are the portions that make up the molecules of your microscopically gigantic protein. Suffice to say, they are considered the building blocks of the latter.

There are 20 amino acids that are known today. Twelve of these are synthesized by the body and thus, are called non-essential amino acids. Meanwhile, eight of these are not made by the body and thus, must be taken through your diet. Hence, they are called essential amino acids.

Your protein contain these amino acids in varying amounts. Some protein sources have more essential amino acids than non-essential ones. These are the ones that you need to avoid as they will just be adding to the ones that the body is already producing.

Role of Amino Acid Supplementation in Adequately-Low Protein Diets

As previously emphasized, essential amino acids are very important in your diet. Since you will be taking a 25-gram protein diet, chances are, you may not get as much essential amino acids as needed in your body.

To counteract this possibility, doctors advise an amino acid supplement that has to be taken with meals. Eating a low protein diet without taking essential amino acid supplementation is sure to cause protein deficiency in time.

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As you meet with your dietitian for the first time, you may feel that you are not eating enough to keep you going. This usually happens in the clinical area. As you go on with your second visit, inform your dietitian about how you feel and how the latter can be resolved.

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The 25g/day Protein

Workbook

Personally, I believe that providing pre-treatment information to patients regardless of pathology increases their degree of compliance towards the latter... and this workbook will do just that. It was developed by Beth Ogata and Cristine Trahms from the Center on Human Development and Disability, University of Washington. Their work has been very impressive as it continues to be used nowadays by physicians and nurses alike. Now, you're getting it for free.

Overall, this workbook has three goals:

a. to help you figure out how much protein you are taking in a regular day

b. to let you know how to reach an adequately-low protein intake of

25g/day

c. to give you a better understanding as to which low-protein foods suit you, without sacrificing your favorite food in the first place.

Before we start, I need you to remember these things:

• Your protein diet needs to be individualized according to your physician, because no diet will work for everyone with different levels of kidney function and condition.

• A low protein diet may seem complicated at first. Give it time. With patience and practice, you will feel like it's a part of your system.

• You are not only doing this for yourself. You're doing it for the people you love and for those who want to keep you off dialysis and transplantation.

So... here's how we do it:

First, we need to determine what you took on the last three days prior to reading this e-book. Don't worry!!! You don't need a time machine to really dig down what happened and when it did.

58

Though you don't need to be thorough, it is helpful to note the foods that directly affect your diet especially meats (proteins), pasta and rice (carbohydrates), and big macs (fats).

Label them down using a table like the one shown below by jotting the foods you ate together with its amount. Refer your answers on the “grams of protein taken” section in Appendix B.

Food Taken and Amount Grams of Protein Taken

Breakfast

Lunch

Dinner

As mentioned earlier, the amount of protein you need in a daily basis varies per individual weight, general kidney functioning, and tolerance to protein. Your nutritionist or dietitian will give you an overview as far as this part is concerned.

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To be safe, we will follow '25g of protein per day' as our standard basis in determining our compliance to the so-called “adequately-low protein diet”. Now... answer the table above. How did you find your diet?

Quantifying Your Daily Protein Intake

Here are the usual animal protein foods that average Americans eat on a regular basis. Check all the foods that you take at least once a week.

_____

_____

_____

_____

_____

beef cheese ice cream frozen yogurt chicken

_____

_____

_____

_____

_____

eggs tuna milk turkey hotdogs

_____

_____

_____

_____

_____

cottage cheese

pork

fish seafoods hamburgers

Questions:

• How many of these foods did you eat in the last 3 days?

• How many servings do you usually eat in a day?

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Important Serving

Sizes of High

Protein Foods

The following protein portion sizes compares how you fare with the recommended diet. Take these values to your previous 3-day food intake table that I asked you to fill up.

The following are examples of food that equates to one serving of protein:

1 ounce fish, poultry, or meat

1 ounce cheese

1 cup milk or yogurt

½ cup tuna or salmon

¾ cup pudding, custard, or ice cream

1 piece egg

½ cup dried beans and peas

¼ cup cottage cheese

2 tbsp peanut butter

3 ounces tofu

Note: A serving of each of these foods account to 8 grams of protein. This is the group that generally has the highest protein content. By the way, it would be way easier for you to calculate the grams of protein per meal if you measure the weight of your meals prior to eating them. Well, I hope this tip helps.

...and here's a better way to estimate the grams of protein you eat per serving. “A piece of cooked meat with the size of a standard deck of cards is usually equivalent to 3 ounces (3 servings).”

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Here are some other examples which I think would be of help to you as you estimate your protein intake. Remember, each serving is equal to 8 grams of protein.

1 slice medium-sized cheese pizza = 2 servings = 16 grams protein

½ cup macaroni and cheese = 1 ½ servings = 12 grams protein

1 hotdog (1 ½ oz) = 1 ½ servings = 12 grams protein

1 chicken drumstick (1 ½ oz) = 1 ½ servings = 12 grams protein

3” by 3” fish fillet (3 oz) = 3 servings = 24 grams protein

½ chicken breast (3 oz) = 3 servings = 24 grams protein

1 pork chop (3 oz) = 3 servings = 24 grams protein

hamburger patty (3 oz) = 3 servings = 24 grams protein

Suffice to say, if you had a 3-ounce hamburger patty and a cup of milk in a meal, you just ate 3 servings (burger) plus 1 serving (milk), which amounts to a total of 4 servings. That would give you 32grams of protein which is already beyond our definition of an adequately-low protein diet.

How many grams of protein did you have yesterday? ...two days ago? How about 3 days ago? What is your average daily protein intake? To answer the latter, add your answers in the first three questions then divide it by three.

Example: Day 1 = 72 grams protein

Day 2 = 148 grams protein

Day 3 = 92 grams protein

Given the aforementioned problem, your estimated average daily protein intake is: 72+148+92= 312 / 3 = 104 g/day

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Serving Sizes of

Medium and Low

Protein Foods

The following foods do not have as much protein as the ones listed in Appendix B but they do have to be considered as well. To guide you through the process of determining your protein intake, check the foods in each group that you enjoy most.

A. Cereals and Grains (generally have about 2 grams of protein per ½ cup or 1 slice;

For small bagels and english muffins, ½ of it = 1 serving.)

_____ cold cereals

_____ croutons

_____ tortillas

_____ muffins

_____ rice

_____ hot cereals

_____ bagels

_____ cookies

_____ animal crackers

_____ potatoes

_____ noodles

_____ rolls

_____ cakes

_____ corn

_____ bread

_____ pita bread

_____ popcorn

_____ saltines

_____ yams

B. Vegetables (generally contain about 1 gram protein per ½ cup serving)

_____ brocolli

_____ green beans/peas

_____ cauliflower

_____ carrots

_____ vegetable juices

_____ cabbage

_____ radishes

_____ mushrooms

_____ spinach

_____ lettuce

_____ squash

_____ asparagus

C. Fruits (½ cup of fruit has trace amounts of protein.)

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_____ apples

_____ raisins

_____ grapes

_____ tomatoes

_____ bananas

_____ fruit cocktail

_____ peaches

_____ fruit juices

_____ oranges

_____ apricots

_____ cherries

_____ melon

_____ kiwis

_____ pears

_____ berries

Now that you can estimate the amount of protein that you are getting, perhaps it is very helpful to re-emphasize here that your body needs a mixture of protein sources.

Take note that in one sitting, you can consume 25g protein/day by merely eating pure chicken meat. This should not be the case. Your protein intake has to be composed of a mixture of high, medium, and low protein sources.

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References

Book Sources:

Black and Hawks. Medical Surgical Nursing: Clinical Management for Positive Outcomes. Elsevier (Singapore) PTE LTD. 2005. 7th Edition.

Bruner and Suddarth. Medical Surgical Nursing. Lippincott Williams and Wilkins. 2004. 10th Edition.

Chiras, Daniel D. Human Biology: Health, Homeostasis, and Environment. Jones and Bartlett Publishers. 2002. 4th Edition.

Kemper, Donald W. British Columbia Health Guide. Healthwise Incorporated. 2005. 2nd Edition.

Langford and Thompson. Mosby's Handbook of Diseases. Elsevier Mosby. 2006. 3rd

Edition.

Lemone and Burke. Clinical Handbook of Medical Surgical Nursing: Critical Thinking in Client Care. Prentice Hall Inc. 2004. 2nd Edition.

Marieb, Elaine N. Essentials of Human Anatomy and Physiology. Pearson Education South Asia PTE LTD. 2004. 7th Edition.

Nettina, Sandra M. Manual of Nursing Practice. Lippincott Williams and Wilkins. 2006. 8th Edition.

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Recipes

Good nutrition is the key to good health for everyone. It is especially important for people with chronic kidney disease.

Even with the help of artificial kidney treatments (dialysis),you cannot get rid of all the wastes and fluids that build up in your body from what you eat and drink.

You can work closely with your renal dietitian to decide on a meal plan that is best for you and includes some of your favorite foods. Your individual meal plan will be based on your age, your weight, foods you like, your dialysis treatments and other medical conditions such as diabetes, heart disease and high blood pressure. It will be tailored to your needs but may not meet the specific needs of other patients. Most people with kidney disease must modify their intake of certain nutrients such as protein, potassium, sodium, phosphorus and fluid. Each person has different needs. Following the meal plan suggested by your renal dietitian will help you feel your best.

Calories are needed to provide your body with energy to allow it to function properly. Your renal dietitian can help you plan a meal plan containing the right balance of calories from different sources to keep your body healthy.

Protein is used to build and repair tissue. Many of the foods you eat contain protein. The best sources of protein are dairy products, eggs, meat, poultry (chicken, turkey, etc.) and seafood. Breads, cereals and vegetables are mostly carbohydrates but also contain a small amount of protein.

Carbohydrates provide fuel or energy for your body in the form of starches and sugars.

The major sources are breads, cereals, fruits, grains and vegetables. If you have diabetes you may be watching your carbohydrate intake to help control your blood sugar.

Fat is a concentrated energy source that adds flavor, moisture and calories to food. It is often added to a meal plan for chronic kidney disease to provide much needed calories to help gain or maintain weight and add flavor to food. If you are overweight and wish to lose weight, your dietitian or doctor may recommend limiting the fat in your diet. Certain kinds of fat may also be recommended for you to use if you are concerned about your blood lipid levels.

Potassium regulates nerve and muscle function. Almost all foods contain some potassium. Some foods that are very high in potassium are avocadoes, bananas, dried beans and peas, dried fruits, milk and nuts, oranges, potatoes, tomatoes and winter squash. How often these foods can be eaten, and/or their portion size, may need to be limited depending on your individual needs.

Calcium and phosphorus are minerals that work together in the body to keep your bones strong and healthy. This balance is changed when the kidneys are unable to filter out enough phosphorus. Phosphorus levels are then increased in your blood. When this balance of calcium and phosphorus is upset it can cause bone disease and contribute to the calcification of

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arteries and organs including your heart. The consistent use of phosphorus binding medication and following a diet that limits foods high in phosphorus may be needed. Almost all foods have some phosphorus, but the highest levels are found in dairy products (cheese, milk, yogurt), dried beans, nuts, chocolate and cola drinks. Your doctor and renal dietitian will help you balance your dietary intake and medications.

Sodium helps regulate the fluid balance in your body. High-sodium foods may upset this balance in chronic kidney disease. Some foods that have the highest amounts of sodium are cured and processed. This includes smoked meats and smoked or processed cheeses, ham, bacon, sausage, cold cuts, cheese and snack foods like corn chips, pickles, pretzels, potato chips, and salted nuts. Some foods that do not taste salty may contain a lot of sodium. Examples are canned soups, ketchup, mustard, relishes, some seasonings, steak sauces, meat tenderizers, canned or packaged foods and restaurant foods. When you prepare foods from scratch, you can control the amount of sodium used.

Healthy Seasoning: The Spice List

When you must limit salt, herbs and spices can add extra flavor to your foods. Most common herbs, spices and seasonings can be used in a meal plan for chronic kidney disease. It is important to use pure spices rather than those mixed with salt. Suggested spices include fresh garlic, fresh lemon or lime juice, garlic powder, pepper, onion powder, paprika, small amounts of green pepper or onion, vinegar and wine.

Avoid using salt substitutes or seasonings that contain potassium chloride. Although most salt substitutes do not contain sodium, most may have a large amount of potassium. Potassium can actually be more harmful to you than salt.

Following are some suggestions for blending spices with specific foods.

Allspice beef, eggs, fish, fruits, vegetables, beverages, baked products, desserts

Basil lamb, fish, eggs, vegetables, sauces

Bay Leaf beef, chicken, veal, fish

Cinnamon chicken, pork, fruits, baked products, beverages, vegetables

Cloves beef, pork, fruits

Curry (salt-free) beef, chicken, lamb, veal, eggs

Dill chicken, veal, fish, vegetables

Ginger chicken, pork, fruits, vegetables, baked products, beverages Marjoram eggs, fish, meats, poultry

Mustard Powder meats, poultry, fish, eggs, vegetables

Parsley beef, chicken, fish, salads, sauces

Rosemary beef, lamb, chicken, turkey

Sage meats, fish, stuffing, vegetables

Savory egg dishes, meats, poultry, stuffing, rice, vegetables

Tarragon chicken, fish, meats, egg dishes, sauces, vegetables

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Thyme fish, meats, poultry, eggs, stuffing, vegetables

It is best to crush or rub leaf-type herbs to release their full flavor. Remember, herbs and spices should not overpower the taste of your food, so add them in small amounts. However, since salt enhances or increases flavors, you may need slightly more of a spice than a standard recipe calls for.

The recipes in this book will help you cook tasty foods that are good for you. Your renal dietitian can help you choose the best ingredients and portion sizes for new or favorite recipes that you may have.

Each recipe has been analyzed for the following nutrients: calories, carbohydrates, protein, fat, sodium, potassium and phosphorus. Each recipe has also been analyzed for renal and renal diabetic exchanges using the National Renal Diet Exchange Lists. (If you are interested in obtaining additional information about these lists, ask your dietitian.) The National Renal Diet Exchange Lists include a “salt exchange” which contains 250 milligrams of sodium. There are recipes in this cookbook that utilize this salt exchange.

Every attempt has been made to analyze these recipes for both renal and renal diabetic exchanges. However, some of these recipes may be too high in sugar for those patients with diabetes.

Those recipes have the comment “Not suitable for patients with diabetes” at the end of the recipe.

Sample Menus

The following seven-day menus have been written to include a variety of recipes from this cookbook. Each day’s menu provides approximately 2000 calories, 70 grams protein, 2 grams sodium, 2 grams potassium, and 1 gram phosphorus. Items with an asterisk (*) are

recipes that can be found in this cookbook. Day 1

Breakfast

Three Pepper Quiche*

2 servings

Pear Halves 1/2 cup

Milk 1/2 cup

Lunch

Cream of Crab Soup* 2 cups Sandwich:

Garlic Bread* 2 slices,

Roast Beef 2 ounces Apple 1 small

Dinner

Turkey Fajitas* 2

Avocado 1/4

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Strawberry Ice Cream* 1 cup

Day 2

Breakfast

Fruit and Oat Pancakes* 2

Margarine 2 teaspoons

Syrup 2 tablespoons

CranApple Juice 1/2 cup

Lunch

Chili Con Carne* 1 cup

Corn Tortillas 2 (6 inch)

Lemonade 1 cup

Dinner

Scampi Linguini* 1 cup

Carrots 1/2 cup

Garlic Bread* 1 slice

Chocolate-Lover’s Mousse* 1/2 cup

Day 3

Breakfast

Cream of Wheat 1 cup

Zucchini Bread* 1 slice

Cranberry Juice Cocktail

1 cup

Margarine 2 teaspoons

Sugar 2 teaspoons

Milk 1/2 cup

Lunch

Pasta Salad Niçoise* 2 cups

Dinner Roll 1

Margarine 2 teaspoons

Hot Fruit Compote* 1/2 cup

Dinner

Meat Loaf* 3 ounces

Broccoli-Cauliflower-Carrot Bake*

1/2 cup

Orzo Pasta* 1/2 cup

French Bread 1 slice

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Margarine 2 teaspoons Peaches 1/2 cup

Day 4

Breakfast

Poached Eggs 2

Toast 2 slices

Margarine 2 teaspoons

Grapes 15 small

Cranberry Juice Cocktail 1 cup

Lunch

Salt-Free Pizza* 2 slices Lettuce 1 cup Salad:

Sliced Cucumber 1/2 cup

Poppy Seed Dressing*

2 tablespoons

Orange 1 small

Dinner

Sweet and Sour Chicken*

1 cup

Egg Fried Rice* 1/2 cup

Chinese Almond Cookies* 3

Plum 1 medium

Day 5

Breakfast

French Toast* 2 slices

Margarine 2 teaspoons

Syrup 2 tablespoons

Orange Juice 1/2 cup

Lunch

Lemon Curry Chicken Salad* 1 1/2 cups

Raspberry Streusel Muffin* 1

Margarine 2 teaspoons

Pine-Apple Fruit Whip* 1 cup

Dinner

Cajun Pork Chop* 1

Festive Cranberry Stuffing* 1/2 cup

Peas 1/2 cup

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Dinner Roll 1

Margarine 2 teaspoons

Day 6

Breakfast

Scrambled Eggs 2

English Muffin 1

Margarine 2 teaspoons

Jelly 1 tablespoon

Peach Nectar 1/2 cup

Lunch Cream of Corn Soup* 1 cup Hamburger:

Hamburger Patty 3 ounces

Hamburger Bun 1

Mayonnaise 2 teaspoons

Fruit Cocktail 1/2 cup

Dinner

Herb Topped Fish* 3 ounces

Barley-Rice Pilaf* 1/2 cup

Steamed Green Beans* 1/2 cup

Dinner Roll 1

Margarine 2 teaspoons

Day 7

Breakfast

Country Biscuits and Gravy*

2 with 1/3 cup gravy Strawberries 1 cup

Lunch

Grilled Chicken Sesame*

1/2 chicken breast

Cottage Cheese Salad*

1/2 cup

Tomato Slices 1/2 medium Frosted Lemon Cookies*

Dinner

Onion Smothered Steak*

2 ounces

Moroccan Couscous*

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1/2 cup

Sunshine Carrots* 1/2 cup

Dinner Roll 1

Margarine 2 teaspoons

Red Hot Jello Salad*

2/3 cup

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Appetizers and Snacks

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Chili Wheat Treats

Ingredients:

1/2 cup margarine

1 tablespoon chili powder 1/2 teaspoon ground cumin

1/2 teaspoon garlic powder

Dash cayenne pepper 4 cups spoon-size shredded wheat

Serves 8 1/2 Cup Per Serving

Directions:

Preheat oven to 300°F. Melt margarine in a 10 x 15-inch baking pan. Stir in spices. Add cereal and toss to coat evenly. Bake for 15 minutes or until crisp. Store in a covered container.

Renal and Renal Diabetic Exchanges:

1 Starch

1 Low Potassium

Vegetable

2 Fat

Analysis: Calories 184

Carbohydrates 16

Protein 3

Fat 12

Sodium 107

Potassium 104

Phosphorus 82

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Holiday Eggnog

Ingredients:

1 1/2 cups liquid non-dairy coffee creamer 1/2 cup frozen eggs or 1/2 cup liquid low-cholesterol egg substitute 2 tablespoons sugar

1 1/2 teaspoons vanilla

Nutmeg

Serves 6 1/3 Cup Per Serving

Directions:

Combine first 4 ingredients in a blender or beat with an electric mixer until well mixed. Chill thoroughly. Serve with a sprinkle of nutmeg.

Renal and Renal Diabetic Exchanges:

1 Milk1 Fat

Analysis: Calories 134

Carbohydrates 13

Protein 3

Fat 8

Sodium 88

Potassium 159

Phosphorus 53

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Onion Bagel Chips

Ingredients:

2 3-1/2-oz plain bagels2 tablespoons margarine, melted

1/2 teaspoon onion powder Serves

4 8 Chips Per Serving

Directions:

Cut each bagel in half vertically, using an electric knife. Place one bagel half, cut side down, on a flat surface; cut vertically into 8 slices. Repeat procedure with remaining bagel halves.

Place slices on baking sheet. Combine margarine and onion powder and brush over bagels.

Bake at 325°F for 20 minutes or until golden and crisp. Remove from pan; cool completely. Store in an airtight container. Makes 32 chips.

Renal and Renal Diabetic Exchanges:

1 Starch 1 Fat

Analysis: Calories 128

Carbohydrates 16

Protein 3

Fat 6

Sodium 208

Potassium 24

Phosphorus 24

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Oriental Egg Rolls

Ingredients:

1 lb diced cooked chicken

1/2 lb bean sprouts

1/2 lb shredded cabbage 1 medium (1 cup) chopped onion

2 tablespoons vegetable oil1 tablespoon low sodium soy sauce

1 clove garlic, minced 1 package (20) egg roll wrappers

Oil for frying

Serves 14 1 Egg Roll Per Serving

Directions:

Mix all ingredients except wrappers and frying oil together in a bowl. Let marinate for 30 minutes. Divide filling among the wrappers and fold as directed on wrapper package instructions. Preheat the oil to 350°F. Fry egg rolls in hot oil (1 inch or more) until golden brown. Drain on paper towels.

Renal and Renal Diabetic Exchanges:

1 Starch

1 Meat 1 Fat

Analysis: Calories 168

Carbohydrates 15

Protein 9

Fat 8

Sodium 152

Potassium 114

Phosphorus 57

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Parmesan Cheese Spread

Ingredients:

1 3-oz package cream cheese

4 tablespoons margarine, softened

1/4 teaspoon garlic powder

2 tablespoons grated

Parmesan cheese 1 tablespoon dry white wine

1 tablespoon minced parsley Dash of thyme

Dash of marjoram

Serves 7 2 Tablespoons Per Serving

Directions:

Mix all ingredients until well blended. Chill for at least 4 hours. Serve with melba toast, unsalted crackers or as a stuffing for celery.

Renal and Renal Diabetic Exchanges:

1/3 Meat 2 Fat

Analysis: Calories 109

Carbohydrates 1

Protein 2

Fat 11

Sodium 115

Potassium 24

Phosphorus 25

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Polynesian Turkey Kabobs

Serves 15 1 Skewer Per Serving

Directions:

In a medium bowl, mix first six ingredients. Shape into 30 meatballs. Arrange on 15 8-inch wooden skewers with pineapple chunks and pepper pieces. Place on broiler pan.

In a small bowl, stir pineapple juice, margarine, marmalade and ginger until blended. Brush over kabobs. Broil 4 inches from heat source for 20 minutes, turning once and basting with sauce.

Ingredients:

1 lb ground raw turkey 1/3 cup unsalted crackers, crushed (5 crackers) 1 egg or 1/4 cup liquid egg substitute

1/4 cup chopped onion

1 teaspoon ground ginger

1 clove garlic, crushed 1 20-oz can pineapple chunks in juice, drained, reserving 1/3 cup juice 1 large red pepper, cut into

22 pieces

1 large green pepper, cutinto 23 pieces

1/3 cup reserved pineapple juice

2 tablespoons margarine, melted2 tablespoons orange marmalade

1 1/2 teaspoons ground ginger

Renal and Renal Diabetic Exchanges:

1 Meat

1 Low Potassium

Vegetable

Analysis: Calories 95

Carbohydrates 9

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Protein 8

Fat 3

Sodium 49

Potassium 187

Phosphorus 72

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Popcorn Munch

Ingredients:

2 cups graham cracker cereal

2 cups sweetened wheat puff cereal

8 cups popped popcorn, unsalted

Serves 8 1 1/2 Cups Per Serving Directions: Mix cereals and popcorn in a microwavable bowl. Microwave on high for 1 1/2 minutes or until hot. Let stand for 5 minutes. Break into pieces.

To make in an oven, mix in a metal pan with sides and bake at 350°F for 6 minutes. Cool 5 minutes and break into pieces.

Renal and Renal Diabetic Exchanges:

1 Starch 1 Fat

Analysis: Calories 122

Carbohydrates 20

Protein 2

Fat 4

Sodium 104

Potassium 71

Phosphorus 46

83

Snack Mix

Ingredients:

1 cup rice cereal squares

1 cup corn cereal squares 1 cup unsalted tiny pretzel twists

3 cups unsalted popped popcorn

1/3 cup margarine, melted

1/2 teaspoon garlic powder

1/2 teaspoon onion powder 1 tablespoon Parmesan cheese

Serves 6 cups 1 Cup Per Serving

Directions:

Mix cereals, pretzels and popcorn in large bowl. Combine melted margarine, garlic powder and onion powder. Pour over cereal mixture and toss to coat. Add Parmesan cheese.

Bake in 350ºF oven for 7–10 minutes. Cool. Store in sealed container.

Renal and Renal Diabetic Exchanges:

1 Starch 2 Fat

Analysis: Calories 180

Carbohydrates 19

Protein 2.5

Fat 11

Sodium 386

Potassium 37

Phosphorus 38

84

Spiced Pineapple Appetizer

Ingredients:

1/4 cup white wine vinegar

3 tablespoons sugar

2 tablespoons lime juice

1/2 teaspoon Dijon mustard 1/4 teaspoon crushed red pepper

1/8 teaspoon garlic powder 1 20-oz can pineapple chunks in juice, drained

Serves 10 5 Pieces Per Serving

Directions:

Combine vinegar, sugar, lime juice, Dijon mustard, pepper and garlic powder in a saucepan. Bring to a boil. Reduce heat and simmer, uncovered, 3 minutes. Combine vinegar mixture and pineapple in a bowl; mix well. Serve warm with toothpicks.

Renal and Renal Diabetic Exchanges: 1 Low Potassium Fruit

Analysis: Calories 47

Carbohydrates 12

Protein 0

Fat 0

Sodium 4

Potassium 67

Phosphorus 4

85

Sweet and Spicy Meatballs

Ingredients: Vegetable cooking spray

1/4 cup chopped onion

1 lb lean ground chuck

1/3 cup fine dry bread

crumbs

1/4 cup chopped fresh parsley

1/8 teaspoon nutmeg 1/4 cup liquid non-dairy creamer

1 egg white, beaten1/2 cup cranberries, finely

chopped

2 teaspoons dry mustard1/8 teaspoon cayenne pepper

1/2 cup grape jelly

1 teaspoon lemon juice

Serves 18 2 Meatballs Per Serving

Directions:

Coat a small saucepan with cooking spray; place over medium heat. Add onion and sauté until tender.

Combine onion with next 6 ingredients in a bowl. Shape into 36 1-inch meatballs. Place meatballs on a baking sheet with sides which has been coated with cooking spray. Bake at 375°F for 18 minutes.

Meanwhile, prepare sauce by combining the cranberries and remaining ingredients in a small saucepan. Cook over medium heat until thoroughly heated.

Place meatballs in a serving bowl and pour the sauce over. Serve with toothpicks.

Renal and Renal Diabetic Exchanges:

1 Meat

1 Low Potassium Fruit

Analysis: Calories 108

Carbohydrates 9

Protein 5

86

Fat 6

Sodium 38

Potassium 98

Phosphorus 44

87

Zippy Dip

Ingredients:

1 package (8 oz) creamcheese, softened

1/2 cup margarine, softened 3 tablespoons green onion, chopped

2 tablespoons mayonnaise

1 tablespoon vinegar

1 1/2 teaspoons lemon juice 1 1/2 teaspoons hot dry mustard

1 teaspoon horseradish

1 teaspoon paprika

1/2 teaspoon garlic powder

1/2 teaspoon tarragon

Dash cayenne pepper

Serves 12 2 Tablespoons Per Serving

Directions:

Blend all ingredients until thoroughly combined. Serve with unsalted crackers or raw vegetables.

Renal and Renal Diabetic Exchanges:

1 Low Potassium

Vegetable 3 Fat

Analysis: Calories 155

Carbohydrates 2

Protein 2

Fat 16

Sodium 133

Potassium 43

Phosphorus 28

88

Breakfasts

89

Country Biscuits and Gravy

Ingredients:

Biscuits

1 1/2 cups flour

2 teaspoons baking powder

2 tablespoons margarine 1/3 cup liquid non-dairy creamer 1/3 cup water

Gravy

6 oz ground beef

1/2 teaspoon sage

1/2 teaspoon pepper

1/2 teaspoon basil

1/2 teaspoon garlic powder

2 tablespoons margarine

2 tablespoons cornstarch 1 cup liquid non-dairy creamer

Serves 4 2 Biscuits & 1/3 Cup Gravy Per Serving

Directions:

For biscuits, combine flour and baking powder in a bowl. Cut in margarine until mixture resembles coarse meal. Add creamer and water, mixing to form a dough. Knead on a floured surface 10 times. Roll dough out and cut into 8 biscuits. Bake on a greased baking sheet at 450°F for 10 to 12 minutes until golden. For gravy, mix ground beef with spices in a bowl. Brown beef in a skillet over medium heat. Drain. Set aside. In the same skillet, melt margarine over low heat. In a small bowl, mix cornstarch with 1/4 cup creamer until smooth. Add remaining creamer and stir until smooth. Add to margarine in skillet and cook over low heat, stirring constantly, until mixture thickens and bubbles. Add beef and heat thoroughly. Serve over biscuits.

Renal and Renal Diabetic Exchanges:

1 Meat

2 Starch

1 Non-Dairy Milk

Substitute

4 Fat

Analysis: Calories 524

90

Carbohydrates 51

Protein 13

Fat 31

Sodium 525

Potassium 311

Phosphorus 393

91

French Toast

Ingredients:

3 eggs

3/4 cup milk

1 tablespoon sugar

1 teaspoon vanilla 1/2 teaspoon cinnamon,

optional

6 slices French bread, cut diagonally, about

1 inch thick

1 tablespoon margarineServes 3

2 Slices Per Serving

Directions:

Beat eggs, milk, sugar, vanilla and cinnamon (optional) together in large bowl, until sugar is dissolved. Soak bread in egg mixture until saturated. Heat margarine in skillet until melted. Cook bread over medium heat until golden brown, about 12 minutes on each side. Serve sprinkled with powdered sugar and/or with pancake syrup of your choice.

Renal and Renal Diabetic Exchanges:

2 Starch

1 Meat

1 Milk

1/2 High Calorie 1 Salt

Analysis: Calories 365

Carbohydrates 47

Protein 15

Fat 13

Sodium 551

Potassium 222

Phosphorus 206

92

Fruit and Oat Pancakes

Ingredients:

1/2 cup rolled oats

1 cup flour

1 8-oz can fruit cocktail,

undrained

1/2 cup liquid non-dairy creamer

1/2 teaspoon baking powder 1 egg or 1/4 cup liquid egg substitute

1 tablespoon margarine

Serves 4 2 Pancakes Per Serving

Directions:

Combine all ingredients except margarine in a bowl. Melt margarine in a large skillet. Drop batter into skillet (about 1/4 cup per pancake) and cook over medium heat until pancakes are bubbly and dry around edges. Flip with a spatula and fry until pancakes are golden brown on the bottom.

Renal and Renal Diabetic Exchanges:

2 Starch

1 Medium Potassium

Fruit 1 Fat

Analysis: Calories 262

Carbohydrates 41

Protein 7

Fat 8

Sodium 152

Potassium 198

Phosphorus 186

93

Mexican Brunch Eggs

Ingredients: 2

tablespoons margarine

1/2 cup chopped onion

2 cloves garlic, crushed 1 1/2 cups frozen corn,

thawed

1 1/2 teaspoons ground cumin

1/8 teaspoon cayenne pepper

8 eggs, beaten, or 2 cups low-cholesterol egg substitute

2 cups unsalted corn chips 2 tablespoons chopped pimiento

Serves 8 1/2 Cup Per Serving

Directions:

In a large skillet, sauté onion and garlic in margarine until onion is soft. Add corn, cumin and cayenne. Stir to combine. Pour in eggs or egg substitute and cook over low heat, stirring occasionally, until eggs are set. Arrange corn chips on a large platter. Spoon egg mixture on chips and sprinkle with pimiento. Serve immediately.

Renal and Renal Diabetic Exchanges:

1 Meat

1 Starch

1 Medium Potassium

Vegetable 1 Fat

Analysis: Calories 214

Carbohydrates 13

Protein 9

Fat 14

Sodium 147

Potassium 240

94

Three Pepper Quiche

Ingredients:

1 tablespoon margarine

1 green pepper, cut in strips 1 sweet red pepper, cut in strips

1 sweet yellow pepper, cut in strips

4 eggs or 1 cup lowcholesterol egg substitute 1/2 cup liquid non-dairy creamer 1/2 cup water

1/2 teaspoon basil 1/8 teaspoon cayenne pepper

1 9-inch pie shell, unbaked Serves 8

1/8 Quiche Per Serving

Directions:

In a large skillet, sauté pepper strips in margarine until soft but not limp. In a bowl, combine eggs or egg substitute, creamer, water, basil and cayenne. Spoon peppers into unbaked pie shell. Pour egg mixture over peppers. Bake at 375°F for 50-55 minutes until a knife inserted in the center comes out clean. Let stand for 10 minutes before serving.

Renal Exchanges:

1 Starch, 1 Low Potassium

Vegetable, 2 Fat

Renal Diabetic Exhanges:

1 Starch, 1 Medium

Potassium Vegetable, 2 Fat

Analysis: Calories 201

Carbohydrates 14

Protein 5

Fat 14

Sodium 222

95

Potassium 163

Phosphorus 50

96

Soups and Salads

97

Bow-Tie Pasta Salad

Ingredients:

2 cups cooked bow-tie pasta

1/4 cup chopped celery 2 tablespoons chopped green pepper 2 tablespoons shredded

carrot

2 tablespoons minced onion

1/8 teaspoon pepper

2/3 cup mayonnaise

1/2 teaspoon sugar

1 tablespoon lemon juice Serves 8

1/3 Cup Per Serving

Directions:

Mix pasta, celery, green pepper, carrot and onion in a bowl. In separate small bowl blend pepper, mayonnaise, sugar and lemon juice until smooth. Pour over pasta and vegetables and mix until well coated. Chill.

Renal and Renal Diabetic Exchanges:

1 Starch 2 Fat

Analysis: Calories 189

Carbohydrates 12

Protein 2

Fat 15

Sodium 111

Potassium 61

Phosphorus 31

98

Chili Con Carne

Ingredients:

1 lb lean ground beef

1 cup chopped onion 1/2 cup chopped green pepper

6 oz no-salt tomato paste

2 tablespoons chili powder

1 teaspoon garlic powder

1/2 teaspoon ground cumin

1/2 teaspoon paprika

1 quart water

Serves 5 1 Cup Per Serving

Directions:

In a large pot, brown the ground beef. Drain fat. Add onion and green pepper. Cook until onion is transparent. Add remaining ingredients and simmer 1 1/2 hours. Before serving, measure chili and add additional water to make 5 cups. Heat through.

Renal and Renal Diabetic Exchanges:

3 Meat

2 Medium Potassium Vegetable

Analysis: Calories 254

Carbohydrates 11

Protein 21

Fat 14

Sodium 118

Potassium 683

Phosphorus 182

99

Cottage Cheese Salad

Ingredients:

2 lb creamed cottage cheese 1 6-oz can juice packed crushed pineapple, drained

1 8-oz carton whipped cream

1 3-oz package Jell-O® —lime or raspberry

Serves 11 1/2 Cup Per Serving

Directions:

Mix dry Jell-O® into cottage cheese. Add drained pineapple. Fold in whipped cream. Refrigerate.

Renal and Renal Diabetic Exchanges:

2 Meat

1/2 Low Potassium

Fruit

1 Salt

Analysis: Calories 191

Carbohydrates 5

Protein 17

Fat 11

Sodium 348

Potassium 105

Phosphorus 122

Cranberry Frozen Salad

Ingredients:

1 8-oz package cream cheese

1/2 pint whipping cream, whipped

1/2 teaspoon vanilla extract

1 16-oz can cranberry sauce

100

Serves 9 3 x 3-inch Piece Per Serving

Directions:

Whip cream cheese with beater until fluffy. Fold in vanilla, whipped cream and then cranberry sauce. Put into a 9 x 9-inch pan. Freeze. Cut into squares and serve frozen.

Renal and Renal Diabetic Exchanges:

1/2 Starch

1 Low Potassium Fruit 3 Fat

Analysis: Calories 255

Carbohydrates 21

Protein 2.5

Fat 19

Sodium 99

Potassium 63

Phosphorus 46

101

Cranberry Salad

Ingredients: 2 3-oz

package raspberry

Jell-O®

1 can whole cranberry sauce (not jellied) 1 cup apples, peeled and chopped

1 cup celery, chopped

1/2 cup unsalted nuts

Serves 8 1/2 Cup Per Serving

Directions:

Mix Jell-O® according to package directions. When cool and syrupy, add cranberry sauce, apples, celery and nuts. Refrigerate until firm.

Renal Exchanges Regular Jell-O®: 1 Low Potassium Fruit, 1 Starch, 1 Fat

Renal Diabetic

Exchanges Diet

Jell-O®: 1 Low Potassium

Fruit, 1 Fat

Analysis: Regular Jell-O® Diet Jell-O®

Calories 179

Carbohydrates 34

Protein 2.4

Fat 5

Sodium 75

Potassium 93

Phosphorus 26

Calories 113

Carbohydrates 15

Protein 2.1

Fat 5

Sodium 75

Potassium 93

102

Cream of Corn Soup

Ingredients: 2

tablespoons margarine

2 tablespoons flour

1/8 teaspoon pepper

1 cup water

1 cup liquid non-dairycreamer

2 jars (128 g each) strainedcream-style corn baby food

Serves 3 1 Cup Per Serving

Directions:

In a saucepan over low heat, melt the margarine. Add flour and pepper. Stir until smooth. Add water and non-dairy creamer gradually. Cook until mixture bubbles. Stir in corn.

Renal and Renal Diabetic Exchanges:

2 Low Potassium Vegetable

1 Non-dairy Milk

Substitute 1 Fat

Analysis: Calories 245

Carbohydrates 22

Protein 3

Fat 16

Sodium 164

Potassium 238

Phosphorus 85

103

Cream of Crab Soup

Ingredients:

1 tablespoon unsaltedmargarine

1/2 medium onion, chopped 1/2 lb imitation crabmeat, shredded 1 quart low-sodium chicken broth 1 cup non-dairy coffee creamer

2 tablespoons cornstarch

1/8 teaspoon dillweed Serves 10

1 Cup Per Serving

Directions:

Melt margarine in a large cooking pot over moderate heat. Add onion and cook, stirring, until soft. Add crabmeat and cook 3 minutes, stirring constantly. Add chicken broth and bring to a boil. Reduce heat to low.

Combine non-dairy creamer and cornstarch in a bowl. Stir until smooth. Add to soup and increase heat to moderate, stirring constantly, until mixture comes to a boil and thickens. Stir in dillweed.

Renal and Renal Diabetic Exchanges:

1 Low Potassium

Vegetable 1 Fat

Analysis: Calories 87

Carbohydrates 7

Protein 4

Fat 5

Sodium 241

Potassium 80

Phosphorus 82

104

Lemon Curry Chicken Salad

Ingredients:

1/4 cup oil 4 tablespoons frozen lemonade concentrate, thawed

1/4 teaspoon ground ginger

1/4 teaspoon curry powder

1/8 teaspoon garlic powder 1 1/2 cups cooked diced chicken

1 1/2 cups grapes, halved1/2

cup sliced celery Serves 4 1

Cup Per Serving

Directions:

In a large bowl, combine oil, lemonade concentrate and spices. Add remaining ingredients and toss lightly. Chill.

Renal and Renal Diabetic Exchanges:

2 Meat

1 Starch 2 Fat

Analysis: Calories 307

Carbohydrates 15

Protein 17

Fat 20

Sodium 57

Potassium 235

Phosphorus 119

105

Pasta Salad Niçoise

Ingredients:

4 cups cooked small shell macaroni

1 tablespoon olive oil2 cups fresh green beans, cut in 1-inch pieces 1/2 cup lemon juice

1/3 cup olive oil

2 teaspoons dry mustard1 tablespoon chopped fresh parsley 1 teaspoon basil 1 7-3/4-oz can tuna packed in water, drained

5 green onions, chopped, including tops 1/4 teaspoon pepper

Serves 6 1 1/2 Cups Per Serving Directions:

Toss pasta with 1 tablespoon olive oil in a bowl. Set aside. Blanch green beans by dropping into boiling water for 2 minutes. Transfer to a colander and chill under cold running water. Drain.

In a large bowl, combine beans, lemon juice, 1/3 cup olive oil, mustard, parsley and basil. Add tuna, green onions, pasta and pepper. Toss, then cover and chill at least 1 to 2 hours.

Renal and Renal Diabetic Exchanges:

2 Meat

1 Starch

1 Low Potassium

Vegetable 1 Fat

Analysis: Calories 304

Carbohydrates 25

Protein 15

Fat 16

Sodium 135

106

Poppy Seed Dressing

Ingredients: 1/4 cup

plus 2 tablespoons wine vinegar 2 tablespoons lemon juice

5 tablespoons sugar

1 teaspoon dry mustard

1/4 small onion, minced

1/2 cup oil

1 tablespoon poppy seedsServes 16 1

Tablespoon Per Serving

Directions:

Mix all ingredients together. Serve with salad of your choice.

Renal and Renal Diabetic Exchanges:

2 Fat

Analysis: Calories 82

Carbohydrates 5

Protein 0

Fat 7

Sodium 0

Potassium 18

Phosphorus 8

107

Red Hot Jell-O® Salad

Ingredients:

1/4 cup cinnamon red hots

1/2 cup water

1 package (3 oz) cherry

Jell-O®

1 cup boiling water 2 cups apples, peeled and chopped

1/2 cup celery, chopped Serves 6

2/3 Cup Per Serving

Directions:

Soak red hots in water overnight. Dissolve Jell-O® in boiling water. Add red hot liquid. Chill until partially set. Stir in apples and celery. Chill until firm.

Renal Exchanges:

1 High Calorie

1/2 Low Potassium Vegetable

Renal Diabetic

Exhanges: 1 Starch

1 High Calorie

Analysis: Calories 113

Carbohydrates 22

Protein 1.2

Fat 0

Sodium 48

Potassium 43

Phosphorus 6

108

Meat, Chicken and Seafood Entrees

109

Baked Halibut

Ingredients:

1 1/2 lb halibut steaks

1/4 cup mayonnaise

3/4 cup bread crumbs Lemon slices dipped in paprika

Serves 7 3 Ounces Per Serving

Directions:

Preheat oven to 400°F. Cut steaks away from bone in center, into serving-size pieces. Cover entirely with mayonnaise. Roll in bread crumbs. Place in buttered baking pan. Bake in preheated oven about 15 minutes or until fish flakes when tested with a fork. Place on heated serving platter. Garnish with lemon slices.

Analysis: Calories 205

Carbohydrates 8

Protein 18

Fat 9

Sodium 176

Potassium 456

Phosphorus 233

Renal and Renal Diabetic Exchanges:

3 Meat

1 Milk

110

Broiled Garlic Shrimp

Ingredients:

1 lb shrimp in shells1/2 cup unsalted margarine, melted

2 teaspoons lemon juice2 tablespoons chopped onion

1 clove garlic, minced

1/8 teaspoon pepper 1 tablespoon fresh parsley, chopped

Serves 5 About 2 1/2 Ounces Shrimp Per Serving Directions:

Preheat broiler. Wash, peel and dry shrimp. Pour margarine in a shallow baking pan and add lemon juice, onion, garlic and pepper. Add shrimp and toss to coat. Broil for 5 minutes. Turn and broil for 5 more minutes. Serve on platter with strained pan juices. Sprinkle with parsley.

Renal and Renal Diabetic Exchanges:

2 Meat

1 Starch

1 Low Potassium Vegetable

Analysis: Calories 264

Carbohydrates 2

Protein 19

Fat 20

Sodium 135

Potassium 189

Phosphorus 192

111

Cajun Pork Chops

Ingredients:

1/4 teaspoon paprika

1/4 teaspoon garlic powder

1/4 teaspoon thyme

1/4 teaspoon dry mustard

1/4 teaspoon ground sage

1/4 teaspoon ground cumin

1/8 teaspoon pepper 4 pork chops cut 1/2-inch thick (4 oz each) 1 small onion, sliced

1 tablespoon margarine

1 teaspoon parsley flakes

1/8 teaspoon garlic powder 2 to 3 drops hot pepper sauce

Serves 4 1 Chop Per Serving Directions:

Combine paprika, 1/4 teaspoon garlic powder, thyme, mustard, sage, cumin and pepper on waxed paper. Coat both sides of pork chops with this mixture. Arrange chops in a single layer on an 8-inch square microwave-safe dish. Top each chop with onion slices. Cover with waxed paper. Microwave on high 5 minutes. Rotate dish and microwave on low (30%) for 25 to 30 minutes or until tender, rotating once during this period. Let rest while preparing sauce. Combine margarine, parsley, 1/8 teaspoon garlic powder and pepper sauce in a small glass bowl. Microwave on high for 30 to 40 seconds until melted. Spoon over chops before serving.

Analysis: Calories 243

Carbohydrates 3

Protein 22

Fat 16

Sodium 75

Potassium 447

Phosphorus 245

Renal and Renal

Diabetic Exchanges:

3 Meat

1 Medium Potassium

112

Vegetable

1 Fat

113

Chicken Veronique

Ingredients:

1 tablespoon flour

1/4 teaspoon pepper

1 lb chicken breast meat 6 tablespoons unsalted margarine 1/4 cup white wine

1/2 cup water

1 teaspoon parsley

1/4 teaspoon pepper

1 bay leaf

2 tablespoons orangemarmalade

1 cup halved white grapes

Serves 5 About 2/3 Cup Per Serving

Directions:

Combine flour and 1/4 teaspoon pepper. Lightly dust chicken. Sauté chicken in margarine in a large skillet until golden brown on all sides. Add remaining ingredients except grapes. Cover and simmer 25 minutes, until tender. Transfer chicken to serving platter. Add grapes to gravy and cook for 2 minutes, stirring constantly.

Pour over chicken.

Analysis: Calories 275

Carbohydrates 13

Protein 22

Fat 15

Sodium 178

Potassium 284

Phosphorus 179

Renal and Renal Diabetic Exchanges:

3 Meat

1 Low Potassium Fruit

114

Fish With Peppers

Ingredients:

1 1/2 lb white fish fillets

1 teaspoon garlic powder

1/2 teaspoon lemon pepper

2 tablespoons oil1/2 cup low-sodium chicken broth

1/4 cup no-salt-added tomato sauce 1 teaspoon capers 1/2 medium green pepper,

cut into rings

1/2 medium red pepper, cut into rings

Serves 5 About 1 Cup Per Serving

Directions:

Cut fish into 4-inch pieces. Sprinkle with garlic powder and lemon pepper. Cook fish in oil in a large skillet over medium heat for 5 minutes, turning often. Add broth, tomato sauce and capers. Reduce heat, cover and simmer 10 minutes. Top with pepper rings and cook 5 minutes longer, until fish flakes easily with a fork and peppers are tender.

Renal Exchanges:

3 Meat, 1 High

Potassium Vegetable

Renal Diabetic

Exhanges: 3 Meat,

2 Medium Potassium Vegetable

Analysis: Calories 205

Carbohydrates 8

Protein 23

Fat 11

Sodium 104

115

Grilled Chicken Sesame

Ingredients:

1 tablespoon sesame seeds,toasted

2 teaspoons grated ginger

2 tablespoons honey 1 tablespoon reducedsodium soy sauce 1 tablespoon sherry 4 4-oz skinned, boned chicken breast halves Vegetable cooking spray

Serves 4 1 Chicken Breast Half Per Serving

Directions:

Combine first 5 ingredients in a small bowl. Set aside. Flatten chicken pieces to 1/4-inch thickness using a mallet or rolling pin.

Spray grill with cooking spray. Grill chicken over medium-hot coals 4 minutes each side, basting frequently with soy sauce mixture. Transfer to serving platter.

Analysis: Calories 179

Carbohydrates 11

Protein 27

Fat 3

Sodium 235

Potassium 302

Phosphorus 232

Renal and Renal Diabetic Exchanges:

3 Meat

1 Low Potassium Fruit

116

Grilled Marinated Beef Steak

Ingredients:

1 1/2 lb chuck steak

1 can (12 oz) beer

1/2 cup sliced green onion 1/4 cup chopped green pepper

2 tablespoons vinegar

1 tablespoon teriyaki sauce

2 tablespoons sugar

2 cloves garlic, minced

1/4 teaspoon pepper

Serves 6 3 Ounces Steak Per Serving

Directions:

Place steak in a large shallow dish. Combine remaining ingredients and pour over steak. Marinate 6 to 8 hours in the refrigerator, turning at least once to let flavors penetrate. Drain the marinade from the steak; reserve. Broil steak over medium coals for 15 to 20 minutes to desired doneness, brushing steak occasionally with reserved marinade.

Renal Exchanges:

3 Meat, 1 Medium

Potassium Vegetable

Renal Diabetic Exchanges:

3 Meat, 2 Low Potassium Vegetable

Analysis: Calories 201

Carbohydrates 12

Protein 25

Fat 6

Sodium 196

Potassium 484

Phosphorus 247

117

Herb Topped Fish

Ingredients:

8 1-1/2 inch thick pieces of salmon, halibut or other white fish (24 oz)

1/2 cup mayonnaise

1/2 cup sour cream 1/4 cup grated Parmesan cheese

4 tablespoons chives, chopped

2 tablespoons parsley, chopped

1/2 teaspoon onion powder

1/2 teaspoon dried dill

1/2 teaspoon dry mustard

Fresh ground pepper to taste Serves

8 3 Ounces Per Serving

Directions:

Place uncooked fish fillets in a buttered shallow baking pan. Blend all remaining ingredients by hand. Spread mixture on top of fillets. Bake at 350°F for 20 minutes or until fish flakes.

Analysis: Calories 244

Carbohydrates 1

Protein 19

Fat 18

Sodium 202

Potassium 316

Phosphorus 239

Renal and Renal Diabetic Exchanges:

3 Meat

2 Fat

118

Lemon Tarragon Chicken

Ingredients:

2 tablespoons margarine 8 medium skinless, boneless chicken breast halves (about 1 1/2 lb) 2 cups fresh mushrooms, halved

2 cloves garlic, minced

3 tablespoons dry sherry1/2 teaspoon dried tarragon, crushed

1/2 teaspoon lemon pepper seasoning

1 3/4 cups salt-free chicken broth 1/3 cup flour

1/4 cup sour cream

Hot cooked noodles

Serves 12 3 Ounces Per Serving

Directions:

In a 12-inch skillet melt margarine over medium heat. Add chicken, mushrooms, garlic, sherry, tarragon and lemon pepper seasoning. Cook, uncovered, for 10 to 12 minutes or until chicken is no longer pink, turning once. Remove chicken and mushrooms with a slotted spoon. In a screw top jar combine chicken broth and flour and shake till blended. Add mixture to the skillet. Cook and stir over medium high heat until thick and bubbly. Remove about 1/2 cup mixture from skillet and stir into sour cream. Return to skillet along with chicken and mushrooms. Heat through (do not boil). Serve over hot cooked noodles. Count noodles as starch exchange.

Renal and Renal Diabetic Exchanges:

3 Meat

1 Low PotassiumVegetable

Analysis without noodles:

Calories 151

Carbohydrates 5

Protein 20 Fat 5

119

Sodium 72

Potassium 306

Phosphorus 181

120

Meat Loaf

Ingredients:

2 beaten eggs

3/4 cup milk

2/3 cup bread crumbs

2 tablespoons onions

1/2 teaspoon sage

1 1/2 lbs ground beef

1/2 cup fresh sliced mushrooms

Topping

1/4 cup salt-free ketchup

2 tablespoons brown sugar

1 teaspoon dry mustard

1/4 teaspoon nutmeg 1/4 cup shredded cheddar cheese

Serves 8 3 Ounces Per Serving

Directions:

Mix all the meat loaf ingredients together and pat into a loaf pan. Bake 1 hour at 350°F. Take out of oven and pour off grease. Mix first four topping ingredients together and put on top of meat loaf. Sprinkle with cheese. Bake until cheese melts.

Renal and Renal Diabetic Exchanges:

3 Meat,1/2 Starch,

1 Low Potassium Vegetable, 1 Fat

Analysis: Calories 335

Carbohydrates 14

Protein 26

Fat 19

Sodium 177

Potassium 416

Phosphorus 22

121

Onion Smothered Steak

Ingredients:

1/4 cup flour

1/8 teaspoon pepper

1 1/2 lb round steak,

3/4-inch thick

2 tablespoons oil

1 cup water

1 tablespoon vinegar

1 clove garlic, minced

1 bay leaf

1/4 teaspoon dried thyme, crushed

3 medium onions, sliced

Serves 8 About 2 oz Meat Per Serving

Directions:

Cut steak into 8 equal servings. Combine flour and pepper and pound into meat. Heat oil in a skillet and brown meat on both sides. Remove from skillet and set aside. Combine water, vinegar, garlic, bay leaf and thyme in the skillet. Bring to a boil. Place meat into this mixture and cover with sliced onions. Cover and simmer 1 hour.

Renal and Renal Diabetic Exchanges:

2 Meat, 1 Low

Potassium Vegetable,

1 Medium Potassium Vegetable, 2 Fat

Analysis: Calories 271

Carbohydrates 7

Protein 18

Fat 19

Sodium 45

Potassium 369

Phosphorus 180

122

Oven Fried Chicken

Ingredients:

1 3-lb broiled-fryer chicken, cut up

1/4 cup shortening

1/4 cup margarine

1/2 cup flour

1 teaspoon paprika

1/2 teaspoon pepper

1/2 teaspoon onion powder Serves

14 3 Ounces Per Serving

Directions:

Preheat oven to 425°F. Wash chicken and pat dry. In oven, melt shortening and margarine in baking pan, 13 x 9 x 2 inches. In medium bowl, mix flour, paprika, pepper and onion powder. Coat chicken pieces thoroughly with flour mixture.

Place chicken skin side down in melted shortening. Cook uncovered 30 minutes.

Turn chicken and cook 30 minutes longer or until thickest pieces are fork tender.

Analysis: Calories 186

Carbohydrates 2

Protein 21

Fat 10

Sodium 119

Potassium 232

Phosphorus 172

Renal and Renal Diabetic Exchanges: 3 Meat

123

Pork With Julienne Vegetables

Ingredients:

4 pork cutlets, 4 oz each

(1/2-inch thick)

2 tablespoons flour 1/2 teaspoon salt-free seasoning 3 tablespoons plus

1 teaspoon margarine

1/3 cup dry white wine

2 tablespoons lemon juice2 cups julienne zucchini strips

1 cup julienne summer squash strips 1/2 cup red bell pepper strips

1 clove garlic, minced

1/4 teaspoon basil

1/8 teaspoon pepper

Serves 4 1 Cutlet, 3/4 Cup Vegetables Per Serving

Directions:

Pound each cutlet to 1/4-inch thick. Combine flour and salt-free seasoning. Dredge cutlets in flour mixture. Braise cutlets in 2 tablespoons margarine in a large skillet over medium-high heat for 5 minutes on each side. Transfer to platter; keep warm. Add wine and lemon juice to pan juices. Heat until reduced to 1/4 cup. Stir in 1 teaspoon margarine. Pour sauce over cutlets. Keep warm.

Place vegetables and 1 tablespoon margarine in skillet. Add garlic, basil and pepper. Cook and stir for 3 or 4 minutes over high heat. Transfer to platter with pork.

Renal and Renal Diabetic Exchanges:

3 Meat

1 Low Potassium

Vegetable 4 Fat

Analysis: Calories 403

Carbohydrates 9

Protein 20

124

Fat 32

Sodium 130

Potassium 388

Phosphorus 218

125

Salt-Free Pizza

Ingredients:

Dough

1/2 package (1 1/4 teaspoon) dry yeast 1 cup warm water

1 tablespoon oil

1 tablespoon sugar

2 cups flour

Sauce

3 oz no-salt tomato paste

1/2 cup water

1/4 teaspoon garlic powder

1/2 teaspoon oregano

1 tablespoon sugar

1 tablespoon oil

1/4 cup chopped onion 1/4 cup chopped green pepper

1/2 lb cooked ground beef, well drained 6 oz mozzarella cheese, shredded

Serves 12 1 Piece Per Serving

Directions:

Dissolve yeast in warm water. Stir in 1 tablespoon oil, 1 tablespoon sugar and enough flour to make a soft dough. Stir 20 strokes. Place in a greased bowl, turn to moisten all surfaces, cover and let set in warm area.

Combine tomato paste, 1/2 cup water, garlic powder, oregano, 1 tablespoon sugar and 1 tablespoon oil in a small saucepan. Simmer 5 minutes.

Grease a 17 x 14-inch baking sheet. Press dough over sheet to edges. Cover with sauce. Top with onion, green pepper, beef and cheese. Bake at 400°F for 20 to 30 minutes until dough and cheese are golden brown. Cut into 12 pieces.

Renal and Renal Diabetic Exchanges:

1 Meat

1 Starch

1 Low Potassium

Vegetable 1 Fat

126

Analysis: Calories 201

Carbohydrates 19

Protein 11 Fat 9

Sodium 75

Potassium 176

Phosphorus 115

127

Scampi Linguini

Ingredients:

1 tablespoon olive oil

1 clove garlic, minced 1/2 lb shrimp, peeled and

cleaned

1/4 cup dry white wine

1 tablespoon lemon juice

1/2 teaspoon basil 1 tablespoon chopped fresh parsley 4 oz dry linguini

Serves 4 About 1/2 Cup Per Serving

Directions:

Heat oil in a large skillet. Add garlic and shrimp. Cook and stir until shrimp turns pink. Add wine, lemon juice, basil and parsley.

Cook 5 minutes longer. Meanwhile, boil linguini in unsalted water until tender. Drain. Serve the linguini topped with the shrimp and any remaining liquid.

Renal Exchanges:

2 Meat, 1 Starch,

1/2 High Calorie

Renal Diabetic Exchanges:

2 Meat, 1 Starch, 1 Low Potassium Fruit

Analysis: Calories 208

Carbohydrates 26

Protein 15

Fat 5

Sodium 86

Potassium 189

Phosphorus 167

128

Spanish Paella

Ingredients:

1/2 lb boned, skinned chicken breasts, cut into 1/2-inch pieces

1/4 cup water

1 10-1/2-oz can low-sodiumchicken broth

1/2 lb medium-size shrimp, peeled and cleaned 1/2 cup frozen green peas 1/3 cup chopped red bell pepper

1/3 cup thinly sliced green onion

2 cloves garlic, minced

1/4 teaspoon pepper

Dash ground saffron 1 cup uncooked instant white rice

Serves 8 1/2 Cup Per Serving

Directions:

Combine first 3 ingredients in a 2-quart casserole, top with lid. Microwave on high for 4 to 5 minutes. Stir in shrimp and next 6 ingredients. Cover and microwave on high for 3 1/2 to 4 1/2 minutes or until shrimp turns pink. Stir in rice. Cover and let stand 5 minutes or until rice is tender.

Renal and Renal Diabetic Exchanges:

2 Meat, 1 Starch,

1 Low Potassium

Vegetable

Calories 163

Carbohydrates 24

Protein 15

Fat 1

Sodium 86

Potassium 178

Phosphorus 144

129

Sweet and Sour Chicken

Ingredients:

1 20-oz can pineapplechunks, juice pack

1/2 cup sugar

2 tablespoons cornstarch

1/2 cup vinegar 2 tablespoons orange marmalade

1/4 cup margarine 1 lb boned, skinned chicken breasts, cut into 1/2-inch cubes 1 green pepper, sliced 1 medium onion, thinly sliced and separated

into rings

3 cups hot cooked white

riceServes 6 1/2 Cup Per

Serving

Directions:

Drain pineapple, reserving 1/3 cup juice. Combine sugar and cornstarch. Mix in pineapple, reserved juice, vinegar and orange marmalade. Set aside. Melt margarine in a wok or large skillet. Add chicken and cook 5 minutes, stirring frequently.

Add green pepper and onion and cook 2 minutes. Add pineapple mixture.

Bring to a boil, stirring occasionally. Serve over rice. Count rice as starch exchange.

Renal and Renal Diabetic Exchanges:

2 Meat

1 Starch

1 Medium Potassium

Fruit

1 High Calorie

Analysis without rice:

Calories 433

Carbohydrates 67

Protein 21

130

Fat 9

Sodium 157

Potassium 427

Phosphorus 192

131

Turkey Fajitas

Ingredients:

1 lb boneless turkey breast

1/4 teaspoon pepper

1 clove garlic, minced

1 teaspoon chili powder 2 tablespoons lime juice 1 tablespoon chopped fresh cilantro (coriander) 1 tablespoon oil

1 cup chopped tomato 2 tablespoons chopped fresh cilantro

1 tablespoon chopped red onion

1/4 teaspoon minced garlic

10 7-inch flour tortillas

3 cups shredded lettuce 1/2 cup light sour cream

Directions:

Sprinkle turkey with pepper, 1 clove minced garlic, chili powder, lime juice, 1 tablespoon cilantro and oil. Turn to coat. Cover and marinate in refrigerator 3 hours or more.

To make salsa, combine tomato, 2 tablespoons cilantro, onion and 1/4 teaspoon garlic in a small bowl. Let stand 1 hour.

Broil turkey 6 inches from heat for 10 minutes each side. Cut into strips. While turkey cooks, wrap tortillas in aluminum foil and warm in oven for 8 minutes. To serve, wrap turkey, salsa, lettuce and sour cream in warm tortillas.

Renal and Renal Diabetic Exchanges:

2 Meat

1 Starch

Analysis: Calories 208

Carbohydrates 19

Protein 13

Fat 9

Sodium 192

Potassium 204

132

Rice, Pasta, Stuffing

133

Barley-Rice Pilaf

Ingredients: 1

tablespoon margarine

1 small yellow onion, chopped

1/3 cup barley

1/3 cup white rice 2 cups low-sodium chicken broth

1 carrot, peeled and chopped fine

1 stalk celery, chopped fine

1/2 teaspoon dried thyme

1/8 teaspoon pepper

Serves 4 1/2 Cup Per Serving

Directions:

In a medium saucepan, melt margarine over moderate heat. Add onion and cook for about 5 minutes or until soft. Add barley and rice and cook, stirring for 1 minute. Add remaining ingredients and bring to boil. Reduce heat and simmer, covered, for 15 minutes or until liquid is absorbed.

Renal and Renal Diabetic Exchanges:

2 Starch

1 Medium Potassium Vegetable

Analysis: Calories 171

Carbohydrates 30

Protein 4

Fat 4

Sodium 83

Potassium 186

Phosphorus 80

134

Egg Fried Rice

Ingredients:

3 tablespoons oil

2 cloves garlic, minced

1/4 cup chopped green onion 1/2 cup cooked chopped pork

4 cups cooked rice 1 teaspoon low-sodium soy sauce

1/2 cup frozen green peas 6 eggs or 1 1/2 cups low-cholesterol egg substitute, scrambled and chopped

1/4 teaspoon dry mustard Serves

6 1 Cup Per Serving

Directions:

Heat oil in large skillet over moderate heat. Add garlic and cook until soft. Stir in onion and cook for 2 minutes. Add pork, rice and soy sauce. Stir and cook for 3 minutes. Add remaining ingredients; cook until heated thoroughly.

Renal and Renal Diabetic Exchanges:

2 Starch

1 Meat

1 Fat

1 Low Potassium Vegetable

Analysis: Calories 270

Carbohydrates 38

Protein 12

Fat 8

Sodium 118

Potassium 202

Phosphorus 173

135

Festive Cranberry Stuffing

Ingredients:

3 cups soft, stale bread crumbs

1 cup diced, peeled, tart apples

1/2 cup diced raw cranberries

1/4 cup chopped celery 1/4 teaspoon poultry seasoning 1/4 cup apple juice 2 tablespoons unsalted margarine, melted

Serves 10 1/2 Cup Per Serving

Directions:

Preheat oven to 350°F. Combine all ingredients in a large bowl and toss to mix. Place in a lightly greased casserole dish. Bake for 30 minutes.

Renal and Renal Diabetic Exchanges:

1 Starch

1 Low Potassium Fruit 1 Fat

Analysis: Calories 150

Carbohydrates 25

Protein 4

Fat 4

Sodium 243

Potassium 79

Phosphorus 45

136

Herbed Rice Dressing

Ingredients:

3/4 cup margarine

1/2 cup chopped onion

1 cup diced celery

5 cups cooked rice 1/2 teaspoon sage

1/2 teaspoon thyme 1/2 teaspoon poultry seasoning

1/2 teaspoon celery seed 1/4 cup chopped fresh parsley

1/4 teaspoon pepper

Serves 12 1/2 Cup Per Serving

Directions:

In a large saucepan, melt margarine over moderate heat. Add onion and celery; cook about 6 minutes, or until tender. Add the remaining ingredients and toss to mix. Stuff in a 10 to 12 lb turkey or bake in a covered casserole dish at 325°F for 1 hour.

Renal and Renal Diabetic Exchanges:

1 Starch

1 Low Potassium

Vegetable 2 Fat

Analysis: Calories 202

Carbohydrates 22

Protein 2

Fat 12

Sodium 126

Potassium 76

Phosphorus 32

137

Moroccan Couscous

Ingredients:

2 tablespoons chopped onion

1/2 tablespoon margarine or olive oil

1 cup water

2/3 cup dry couscous

Serves 4 1/2 Cup Per Serving

Directions:

Sauté chopped onion in the margarine or olive oil until tender. In medium saucepan bring water to a boil. Stir in couscous and onion. Let stand 5 minutes. Fluff lightly with fork before serving.

Renal and Renal Diabetic Exchanges:

1 1/2 Starch

Analysis: Calories 115

Carbohydrates 21

Protein 3.5

Fat 2

Sodium 24

Potassium 61

Phosphorus 22

138

Orzo Pasta

Ingredients:

1 1/3 cups (8 oz) dry orzo

pasta 3 quarts water

2 teaspoons olive oil

1/2 teaspoon garlic powder 1/2 teaspoon Italian seasoning (blend of marjoram, thyme, rosemary, savory, sage, oregano and basil) 1 tablespoon grated

Parmesan cheese

Serves 6 1/2 Cup Per Serving

Directions:

Bring the 3 quarts of water to a rolling boil. Add orzo pasta to water and stir.

Return to a boil and cook, uncovered, 9 to 11 minutes. For best results, avoid overcooking. Remove from heat and drain well in colander. Pour drained pasta into serving bowl. Add olive oil, garlic powder, Italian seasoning and Parmesan cheese. Toss gently and serve as a side dish accompaniment as you would any other pasta.

Renal and Renal Diabetic Exchanges:

2 Starch

Analysis: Calories 137

Carbohydrates 27

Protein 6.5

Fat 3

Sodium 20

Potassium 76

Phosphorus 92

139

Pasta With Pesto

Ingredients:

1/4 cup olive oil

1/4 cup grated Parmesan cheese

1/4 cup chopped fresh parsley

2 tablespoons dried basil

1 clove garlic, minced

1 lb pasta, uncooked

Serves 8 1/2 Cup Per Serving

Directions:

Combine all ingredients except pasta in a blender or food processor. Blend or process until smooth.

Cook pasta in unsalted boiling water according to package directions. Toss sauce with drained pasta. Serve hot.

Renal and Renal Diabetic Exchanges:

1 Starch

1 Low Potassium

Vegetable 15 Fat

Analysis: Calories 283

Carbohydrates 45

Protein 8

Fat 8

Sodium 45

Potassium 146

Phosphorus 115

140

Vegetables

141

Broccoli-Cauliflower-Carrot Bake

Ingredients:

3 cups broccoli, raw

2 cups cauliflower, raw 1 cup frozen whole small onions or 3 medium onions quartered 1 cup carrots

4 tablespoons butter

2 tablespoons flour

Dash pepper

1 cup milk

1 package (3 oz) cream cheese, softened 1/2 cup sharp cheddar cheese, shredded 1/2 cup soft bread

crumbs Serves 12 1/2 Cup Per Serving

Directions:

Wash and cut vegetables; steam until crisp but tender. Drain. In saucepan, melt 2 tablespoons of the butter; blend in flour and pepper. Add milk. Cook and stir until bubbly and thick. Reduce heat; blend in cream cheese until smooth. Place vegetables in 1 1/2-quart casserole dish. Pour sauce over and mix lightly. Top with shredded cheese. Bake 15 minutes at 350°F. Mix together the bread crumbs and remaining butter and sprinkle on casserole. Bake an additional 25 minutes.

Renal and Renal Diabetic Exchanges:

1 Medium Vegetable

1/2 Meat 1 Fat

Analysis: Calories 116

Carbohydrates 7

Protein 3.9

Fat 9

Sodium 130

Potassium 225

Phosphorus 83

142

Broccoli Blossom

Ingredients:

1/4 cup chopped onion

1 cup chopped red cabbage

1/2 cup chopped broccoli

1 tablespoon oil

2 to 3 tablespoons water

1/4 teaspoon tarragon

1/4 teaspoon garlic powder

1/4 teaspoon onion powder

Black pepper

Red pepper

1 English muffin, split andtoasted

2 tablespoons grated

Parmesan cheese

Serves 2 1/2 English Muffin and 3/4 Cup Vegetable Topping Per Serving

Directions:

Stir-fry vegetables in oil in a large skillet or wok over medium heat for 2 to 3 minutes.

Add water and cover. Steam for 5 minutes. Add spices during last 2 minutes. Serve over English muffin halves. Sprinkle with Parmesan cheese.

Renal and Renal Diabetic Exchanges:

1 Starch

1 High Potassium

Vegetable 1 Fat

Analysis: Calories 174

Carbohydrates 17

Protein 6

Fat 9

Sodium 287

Potassium 339

Phosphorus 108

143

Crispy Fried Okra

Ingredients:

1 pint fresh okra, cut into

1-inch segments, or 1 16-oz package frozen okra 1/2 cup flour

1/2 cup cornmeal

1/4 teaspoon pepper

2 tablespoons margarine

1 cup beer or water

Serves 4 1/2 Cup Per Serving

Directions:

Thaw okra if frozen. In a medium bowl, combine flour, cornmeal and pepper. Cut in margarine until crumbly. Dip okra in beer or water, then roll in cornmeal mixture to coat. Place on a greased baking sheet. Bake at 350°F for 20 minutes or until golden brown. Serve hot with toothpicks and low-sodium ketchup.

Renal Exchanges:

2 Starch, 1 Medium

Potassium Vegetable

Renal Diabetic

Exchanges: 2 Starch,

1 Medium PotassiumVegetable, 1 Fat

Analysis: Calories 215

Carbohydrates 36

Protein 4

Fat 6

Sodium 56

Potassium 208

Phosphorus 71

144

Hot German Cabbage

Ingredients:

2 tablespoons sugar

1 tablespoon minced onion

1/2 teaspoon caraway seed

1/2 teaspoon dry mustard

1/4 teaspoon pepper

3 tablespoons vinegar

2 tablespoons margarine

4 cups shredded red cabbage 1 cup unpeeled diced green apple

Serves 6 2/3 Cup Per Serving

Directions:

Combine sugar, onion, caraway seed, dry mustard, pepper and vinegar in a bowl. Mix well and set aside. Melt margarine in a large skillet. Sauté cabbage and apple in skillet over medium heat for 3 minutes. Stir in vinegar mixture and simmer over low heat for 5 minutes, stirring occasionally, until cabbage is tender.

Renal and Renal Diabetic Exchanges:

1 Medium Potassium

Vegetable 1 Fat

Analysis: Calories 77

Carbohydrates 9

Protein 1

Fat 4

Sodium 36

Potassium 128

Phosphorus 26

145

Steamed Green Beans

Ingredients:

1 tablespoon vegetable oil1 pound green beans, trimmed

1/2 cup diced sweet red pepper

2 tablespoons water

1/2 teaspoon basil

1/4 teaspoon pepper

1 tablespoon lemon juice Serves 4

1/2 Cup Per Serving

Directions:

In 12-inch heavy skillet with tight-fitting lid, place all ingredients except lemon juice. Cover and cook over medium heat, shaking pan occasionally to prevent sticking, 15 minutes or until tender-crisp. Toss with lemon juice.

Renal and Renal Diabetic Exchanges:

1 Medium Potassium Vegetable

Analysis: Calories 47

Carbohydrates 6

Protein 1.5

Fat 2

Sodium 5

Potassium 180

Phosphorus 31

146

Summer Vegetable Sauté

Ingredients: 2

tablespoons margarine

2 cups sliced zucchini

1/2 cup diced green pepper 1 10-oz package frozen corn, thawed 2 tablespoons chopped pimiento

1/8 teaspoon garlic powder

1/8 teaspoon pepper

Serves 6 1/2 Cup Per Serving

Directions:

Heat margarine in a large skillet. Add remaining ingredients and sauté until vegetables are tender, about 15 minutes.

Renal and Renal Diabetic Exchanges:

2 Low Potassium

Vegetable 1 Fat

Analysis: Calories 81

Carbohydrates 9

Protein 2

Fat 4

Sodium 38

Potassium 175

Phosphorus 38

147

Breads

148

Garlic Bread

Ingredients:

3 tablespoons vegetable oil

4 cloves garlic, minced

2 teaspoons paprika

Dash cayenne pepper

1 teaspoon lemon juice

2 tablespoons grated

Parmesan cheese

3/4 cup mayonnaise

1 loaf (1 lb) French bread

1 teaspoon Italian herbs

Serves 16 1/8 of a Half-Loaf Per Serving

Directions:

Pour oil into a small bowl. Add garlic to oil and let stand overnight. Next day, strain garlic from oil, reserving oil. Discard garlic. Add paprika, cayenne, lemon juice and Parmesan. Mix well. Stir in mayonnaise. Slice loaf of bread in half lengthwise. Spread each half generously with garlic spread. Place both halves under the broiler and broil until golden brown. Serve hot.

Renal and Renal Diabetic Exchanges:

1 Starch2 Fat

Analysis: Calories 175

Carbohydrates 14

Protein 3

Fat 12

Sodium 153

Potassium 38

Phosphorus 31

149

Gingerbread

Ingredients:

2 teaspoons lemon juice orvinegar 1/2 cup skim milk

1 egg

1 tablespoon brown sugar2 tablespoons brown sugar substitute

2 tablespoons molasses

1 tablespoon margarine

1 cup sifted flour

1/2 teaspoon baking soda

1/4 teaspoon cinnamon

1 1/2 teaspoons ginger

Pinch of cloves

Serves 12 2 x 2 1/2-inch Pieces Per Serving

Directions:

In a small bowl, add 2 teaspoons lemon juice or vinegar to 1/2 cup skim milk to make sour milk. Set aside. Beat egg with sugar, sugar substitute and molasses until fluffy. Mix sour milk, margarine, sifted flour, baking soda and spices together. Add egg and sugar mixture and beat until smooth. Bake in an 8-inch greased pan at 350°F for 25 to 30 minutes.

Renal and Renal Diabetic Exchanges:

1 Starch

Analysis: Calories 71

Carbohydrates 12

Protein 2

Fat 2

Sodium 71

Potassium 71

Phosphorus 28

150

Pineapple Bread

Ingredients:

1/3 cup sugar

1/3 cup margarine

2 eggs

2 cups flour

3 teaspoons baking powder1 cup crushed pineapple in juice, undrained 6 maraschino cherries, chopped

Serves 20 1 Slice Per Serving

Directions:

Beat sugar and margarine until light and fluffy. Add eggs and mix well. Mix flour and baking powder together. Combine sugar and flour mixtures. Blend. Add pineapple and cherries and mix to combine. Pour into greased 9 x 5-inch pan. Bake at 350°F for 1 hour. Cut into 20 slices.

Renal and Renal Diabetic Exchanges:

1 Starch 1 Fat

Analysis: Calories 103

Carbohydrates 15

Protein 2

Fat 4

Sodium 133

Potassium 38

Phosphorus 94

151

Raspberry Streusel Muffins

Ingredients:

1 1/3 cups flour 1 1/2 teaspoons baking powder

1 cup fresh or frozen raspberries 1/4 cup margarine

1/2 cup sugar

1 egg

1/2 cup liquid non-dairy creamer

1/4 cup brown sugar

1/4 cup flour

2 tablespoons margarine

2 teaspoons cinnamon

Serves 16 1 Muffin Per Serving

Directions:

Preheat oven to 375°F. Line 16 muffin cups with paper liners.

Mix 1 1/3 cups flour and baking powder in a small bowl. Stir in raspberries. In a medium bowl, beat 1/4 cup margarine with sugar and egg. Blend in creamer. Stir in flour mixture, just until moistened. Spoon into 16 muffin cups.

In a small bowl, mix brown sugar, 1/4 cup flour, 2 tablespoons margarine and cinnamon. Sprinkle over muffins. Bake 15 to 18 minutes.

Renal and Renal Diabetic Exchanges:

1 Starch 1 Fat

Analysis: Calories 138

Carbohydrates 19

Protein 2

Fat 6

Sodium 111

Potassium 56

Phosphorus 69

152

Soft Pretzels

Ingredients:

1 package dry yeast

3/4 cup warm water

1 tablespoon sugar

2 cups flour

2 tablespoons milk

1 tablespoon sesame seeds Serves 12 1 Pretzel Per Serving

Directions:

In a large bowl, mix yeast and warm water. Mix in sugar. Beat in flour. Knead in bowl until smooth, about 10 minutes. Place dough on a floured board and divide into 12 equal pieces. Roll each piece into a rope 12 inches long. Shape each rope into a pretzel. Place on a greased baking sheet, brush with milk and sprinkle with sesame seeds. Bake at 425°F for 12 to 15 minutes or until browned. Cool on a rack.

Renal and Renal Diabetic Exchanges:

1 Starch

Analysis: Calories 86

Carbohydrates 16

Protein 3

Fat 1

Sodium 3

Potassium 61

Phosphorus 48

153

Zucchini Bread

Ingredients:

3 eggs

1 1/2 cups sugar

1 cup applesauce

2 cups unpeeled zucchini,shredded 1 teaspoon vanilla

2 cups flour

1/4 teaspoon baking powder

1 teaspoon baking soda

1 teaspoon cinnamon

1/2 teaspoon ginger

1 cup unsalted chopped

nutsServes 16 1 Slice Per

Serving

Directions:

Beat eggs. Mix sugar, applesauce, zucchini and vanilla into eggs. Sift dry ingredients together and add to mixture. Pour into a loaf pan and bake at 375°F for 1 hour. Cut into 16 slices.

Renal and Renal Diabetic Exchanges:

2 Starch

1 Low Potassium

Vegetable 1 Fat

Analysis: Calories 202

Carbohydrates 34

Protein 3.7

Fat 6

Sodium 69

Potassium 110

Phosphorus 62

154

Desserts

155

Apple Cake With Warm Honey Sauce

Ingredients:

1/3 cup lemon juice

3 cups diced peeled apples

3 tablespoons margarine

1/2 cup sugar

1/2 cup honey

1 egg

2 cups flour

1 teaspoon baking powder

1/2 teaspoon baking soda

1/4 teaspoon nutmeg

2 1/2 teaspoons cornstarch

1/2 cup honey

1/3 cup water

1 tablespoon grated lemon peel

3 tablespoons lemon juice

1 tablespoon margarine

Dash nutmeg

Serves 9 1 3-inch Square of Cake With 2 1/2 Tablespoons Sauce Per Serving

Directions:

Preheat oven to 350°F. Pour 1/3 cup lemon juice over apples and coat. Set aside. Cream margarine and sugar. Add honey and beat well. Add egg and mix. Sift flour, baking powder, baking soda and nutmeg together and add to margarine mixture. Stir in apples. Pour into a greased 9-inch square baking pan. Bake for 55 to 60 minutes. For sauce, mix cornstarch, honey and water together in a small saucepan. Add lemon peel. Cook over moderate heat for about 5 minutes or until thick, stirring occasionally. Remove from heat and stir in 3 tablespoons lemon juice, margarine and nutmeg.

Renal and Renal Diabetic Exchanges:

2 Starch

1 Fat

1 Low Potassium Fruit

1 High Calorie

Analysis:

156

Calories 335

Carbohydrates 66

Protein 4

Fat 6

Sodium 172

Potassium 111

Phosphorus 93

157

Baked Custard

Ingredients: 1/2 cup

lowfat (2%) milk

1 egg

1/8 teaspoon nutmeg

1/8 teaspoon vanilla

Artificial sweetener

Serves 1 1/2 Cup Per Serving

Directions:

Scald milk, then cool slightly. Break egg into small bowl and beat slightly with nutmeg. Add scalded milk, vanilla and sweetener to taste. Mix well. Set bowl in a baking pan with water 1/2 inch deep. Bake at 325°F for 30 minutes.

Renal and Renal Diabetic Exchanges:

1 Milk

1 Meat

Analysis: Calories 135

Carbohydrates 7

Protein 10

Fat 7

Sodium 124

Potassium 249

Phosphorus 205

158

Brandy Apple Crisp

Ingredients:

4 cups peeled, coarsely chopped tart apples 3 tablespoons sugar

3 tablespoons brandy

2 teaspoons lemon juice

1/2 teaspoon cinnamon

1/8 teaspoon nutmeg

3/4 cup dry oats

1/4 cup brown sugar

2 tablespoons flour

2 tablespoons margarine Serves 6

1/2 Cup Per Serving

Directions:

Combine first 6 ingredients in an 8-inch square baking pan. Toss well; set aside. Combine oats, brown sugar and flour in small bowl. Cut in margarine until well blended. Sprinkle over apple mixture. Bake at 350°F for 45 minutes.

Renal and Renal Diabetic Exchanges:

1 Starch

1 Medium Potassium

Fruit 1 Fat

Analysis: Calories 203

Carbohydrates 38

Protein 2

Fat 5

Sodium 36

Potassium 159

Phosphorus 59

159

Cherry Berry Pie

Ingredients:

1 cup canned, unsweetened cherries, drained, juice reserved

1 cup canned unsweetened raspberries, drained, juice reserved 3/4 cup of the reserved cherry and raspberry juices (if necessary, add water to make 3/4 cup) 3/4 cup sugar

1 tablespoon cornstarch

1/4 teaspoon almond extract Pastry for 2-crust pie, unbaked

Serves 8 1/8 Pie Per Serving

Directions:

In a small saucepan, combine juices, sugar and cornstarch. Cook over low heat until thick and clear, stirring often. Add cherries, raspberries and almond extract. Pour into pie shell. Cover with other pie shell and seal edges. Make small slits in top crust to allow steam to escape. Bake at 450°F for 15 minutes. Reduce heat to 375°F and continue baking for 25 to 30 minutes or until crust is golden brown.

Renal and Renal Diabetic Exchanges:

2 Starch

1 Low Potassium Fruit 3 Fat

Analysis: Calories 343

Carbohydrates 46

Protein 4

Fat 16

Sodium 120

Potassium 102

Phosphorus 36

160

Chinese Almond Cookies

Ingredients:

1 cup margarine, softened

1 cup sugar

1 egg

3 cups flour

1 teaspoon baking soda

1 teaspoon almond extract Serves 24

3 Cookies Per Serving

Directions:

In a medium mixing bowl, cream margarine and sugar. Add egg and beat well. Sift dry ingredients and add to creamed mixture. Add almond extract and mix well. Roll into balls about 3/4 inch in diameter. Press a small hole in the middle of each cookie. Bake at 400°F for 10 to 12 minutes, until cookies are golden brown around edges.

Renal Exchanges:

1 Starch

1 Fat

Renal Diabetic Exchanges:

1 Starch, 2 Fat

Analysis: Calories 158

Carbohydrates 20

Protein 2

Fat 8

Sodium 99

Potassium 18

Phosphorus 17

161

Chocolate Chip Cookies (Sugar Free)

Ingredients:

1 cup flour

1/2 teaspoon baking soda

1/4 teaspoon salt

1/2 cup margarine or butter 4 teaspoons liquid sugar substitute 1/2 teaspoon vanilla

1 egg, beaten 1/2 cup semi-sweet chocolate chips

Serves 18 2 Cookies Per Serving

Directions:

Sift together dry ingredients. Cream margarine. Add sugar substitute, vanilla and egg, blending well. Add flour mixture and beat well. Stir in chocolate chips. Drop by teaspoonfuls onto a greased baking sheet. Bake 10 minutes at 375°F.

Renal and Renal Diabetic Exchanges:

1 Starch1 Fat

Analysis: Calories 99

Carbohydrates 8

Protein 1.4

Fat 7

Sodium 98

Potassium 28

Phosphorus 19

162

Chocolate-Lover’s Mousse

Ingredients:

2 tablespoons sugar1/2 teaspoon unflavored gelatin 1/4 cup milk 1/2 cup semi-sweet chocolate minichips 1 teaspoon vanilla 1/2 cup heavy cream, whipped

Serves 2 1/2 Cup Per Serving

Directions:

Combine sugar and gelatin in a small saucepan; stir in milk. Allow gelatin mixture to soften a few minutes. Place over medium heat, stirring constantly, until mixture just begins to boil. Remove from heat; immediately add chocolate chips, stirring until melted. Blend in vanilla; cool to room temperature. Beat heavy cream until stiff; gradually add chocolate mixture to cream, folding gently just until combined. Chill completely; garnish with dessert topping before serving, if desired.

Renal and Renal Diabetic Exchanges:

1 Milk

2 High Calorie5 Fat

163

Analysis: Calories 487

Carbohydrates 40

Protein 5.5

Fat 38

Sodium 46

Potassium 242

Phosphorus 111

164

Cinnamon Crispies

Ingredients: 1

tablespoon hot water

1/2 teaspoon vanilla

1 1/2 tablespoons sugar

1 teaspoon cinnamon

4 6-inch flour tortillas

2 tablespoons margarine, melted

Serves 4 1 Tortilla Per Serving

Directions:

Combine water and vanilla in a small bowl; stir well. Combine sugar and cinnamon; stir well. Brush both sides of tortillas with margarine, brush each side with water mixture and sprinkle each side with sugar mixture.

Place tortillas on a wire rack in a jelly roll pan. Bake at 400°F for 6 1/2 minutes or until lightly browned.

Renal and Renal Diabetic Exchanges:

1 Starch 2 Fat

Analysis: Calories 168

Carbohydrates 21

Protein 3

Fat 8

Sodium 83

Potassium 35

Phosphorus 26

165

Frosted Lemon Cookies

Ingredients:

1/2 cup margarine

1 cup sugar

2 eggs or 1/2 cup lowcholesterolegg substitute 1 teaspoon vanilla

2 cups flour

1/2 teaspoon baking soda

1/4 cup lemon juice

1 1/2 cups powdered sugar

2 tablespoons water

1/2 teaspoon lemon extract Serves

36 1 Cookie Per Serving

Directions:

Preheat oven to 375°F. Cream margarine and sugar in a mixing bowl until light and fluffy. Add eggs or egg substitute and vanilla and beat well. Stir flour and baking soda together in a small bowl. Add to creamed mixture. Beat in lemon juice. Drop by teaspoonfuls onto un-greased baking sheet. Bake for 10 to 12 minutes or until cookies are light golden brown. Cool. In a small bowl, beat powdered sugar, water and lemon extract until smooth. Spread on cooled cookies.

Renal and Renal Diabetic Exchanges:

1 Starch

Analysis: Calories 92

Carbohydrates 15

Protein 1

Fat 3

Sodium 39

Potassium 21

Phosphorus 10

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Hot Fruit Compote

Ingredients:

1 (28 oz) can each:

Pear slices, juice packed Peach slices, juice packed

Pineapple chunks, juice packed Cherry pie filling

2 cups crushed corn flakes

1/4 cup margarine, melted

Serves 12 3 x 4 Inch Square Per Serving

Directions:

Drain fruit. Grease a 9 x 13-inch pan and layer fruit, ending with pie filling. Crush corn flakes, mix with margarine and sprinkle over fruit. Bake at 350°F for 30 minutes. Serve warm.

Renal and Renal Diabetic Exchanges:

1 Starch

1 High Potassium Fruit 1 High Calorie

Analysis: Calories 213

Carbohydrates 47

Protein 1.5

Fat 4

Sodium 115

Potassium 286

Phosphorus 32

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Maple Crisp Bars

Ingredients:

1/3 cup margarine

1 cup sugar

1 teaspoon maple extract 1/2 cup maple pancake syrup (not pure maple syrup)

8 cups puffed rice cereal Serves

20 1 Bar Per Serving

Directions:

In a large saucepan, melt margarine over moderate heat. Stir in sugar, extract and syrup; bring to a boil. Remove from heat. Stir in cereal, coating it well with sugar mixture.

Press into a greased 13 x 9-inch baking pan. Chill. Cut into 20 bars.

Renal and Renal Diabetic Exchanges:

1 High Calorie Not suitable for patients with diabetes.

Analysis: Calories 110

Carbohydrates 21

Protein 0

Fat 3

Sodium 26

Potassium 10

Phosphorus 6

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Pine-Apple Fruit Whip

Ingredients:

1 envelope unflavored gelatin

1 cup canned unsweetened pineapple juice

1/4 teaspoon grated lemon peel

3 tablespoons honey 2 cups unsweetened applesauce Cinnamon or nutmeg

Serves 8 1/2 Cup Per Serving

Directions:

In a saucepan, sprinkle gelatin over pineapple juice to soften, and stir over low heat until gelatin is dissolved. Stir in lemon peel, honey and applesauce. Refrigerate, stirring occasionally. When mixture mounds slightly if dropped from spoon, beat until fluffy. Divide among 8 dessert dishes. Refrigerate until firm. Garnish each with a dash of cinnamon or nutmeg.

Renal and Renal Diabetic Exchanges:

1 Medium Potassium Fruit

Analysis: Calories 71

Carbohydrates 18

Protein 1

Fat 0

Sodium 3

Potassium 114

Phosphorus 8

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Pineapple Delite Pie

Ingredients: 2/3 cup graham cracker crumbs

2 1/2 tablespoons margarine, melted 1 20-oz can juice packed crushed pineapple 1 small package sugar-free pineapple gelatin 1 tablespoon lemon juice

2 egg whites 1/4 teaspoon cream of tartar

Serves 8 1/8 Pie Per Serving

Directions:

Combine cracker crumbs and margarine in a small bowl. Press into bottom and sides of an 8-inch pie plate. Bake at 425°F for 5 minutes; cool.

Drain pineapple juice into a saucepan. Sprinkle gelatin over juice and melt over low heat. Remove from heat and add pineapple and lemon juice; cool.

Beat egg whites and cream of tartar until stiff peaks form. Gently fold in pineapple mixture. Spoon into crust. Chill several hours.

Renal Exchanges:

1 Starch, 1 Medium Potassium Fruit

Renal Diabetic Exchanges: 1 Starch, 1 Medium Potassium Fruit, 1 Fat

Analysis: Calories 153

Carbohydrates 24

Protein 3

Fat 5

Sodium 167

Potassium 19

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Strawberry Ice Cream

Ingredients:

1 10-oz package frozen sweetened strawberries 1 tablespoon lemon juice

1 cup crushed ice 3/4 cup non-dairy coffee creamer 1/2 cup sugar Few drops red food coloring

Serves 6 1/2 Cup Per Serving Directions: Thaw strawberries just until they break into chunks. Place all ingredients in a blender. Blend until smooth and sugar is dissolved. Pour into a covered dish. Freeze until firm.

Renal and Renal Diabetic Exchanges:

1 Starch

1 Low Potassium Fruit

Analysis: Calories 144

Carbohydrates 28

Protein 1

Fat 3

Sodium 25

Potassium 108

Phosphorus 25

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Strawberry Pizza

Ingredients:

Crust (pre-packaged) 1 package refrigerated sugar cookie dough

Crust (homemade)

1 cup flour

1/4 cup powdered sugar

1/2 cup butter

Filling

8 oz cream cheese, softened

1/2 teaspoon vanilla

1/2 cup sugar

2 cups sliced strawberries

Glaze

1 cup mashed strawberries

4 tablespoons sugar

1 tablespoon cornstarch Serves

12 1 Slice Per Serving

Directions:

Pre-packaged crust

Roll out cookie dough into a round pizza pan. Bake according to directions on package. Cool.

Homemade crust

Mix flour, sugar and butter together and press into round pizza pan. Bake 15 minutes at 350°F.

Beat cream cheese, vanilla and sugar until fluffy. Spread over cooled crust. Then spread sliced strawberries over filling. Cook the mashed strawberries, sugar and cornstarch until clear. Spread over sliced berries. Chill. (You can also substitute a packaged glaze mix.)

Renal and Renal Diabetic Exchanges:

1 Starch

1 Low Potassium Fruit

2 Fat

Analysis: Homemade Pre-packaged

Calories 242

172

Carbohydrates 26

Protein 2.8

Fat 15

Sodium 135

Potassium 98

Phosphorus 40

Calories 221

Carbohydrates 28

Protein 2.4

Fat 11

Sodium 160

Potassium 94

Phosphorus 40

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Sugar-Free Pumpkin Cheese Pie

Ingredients:

1 1/4 cups graham cracker crumbs

1/3 cup unsalted margarine, melted

8 oz cream cheese, softened 1/2 cup pumpkin

17 packets sugar substitute 2 eggs or 1/2 cup low-cholesterol egg substitute 1 teaspoon vanilla

1 teaspoon cinnamon

1/2 teaspoon nutmeg

12 packets sugar substitute

1 cup water

2 drops red food coloring

1 tablespoon cornstarch

2 teaspoons lemon juice

2 cups fresh cranberries Serves 8

1/8 Pie Per Serving

Directions:

In a small bowl, combine graham cracker crumbs and margarine. Press into bottom and sides of a 9-inch glass pie plate. In a glass bowl, combine cream cheese, pumpkin, 16 packets sugar substitute, eggs or egg substitute, vanilla, cinnamon and nutmeg. Beat until smooth. Microwave on high for 3 to 5 minutes until hot but not set. Stir frequently. Pour into pie shell. Microwave on high for 5 to 7 minutes or until knife inserted in center comes out clean. Sprinkle one packet of sugar substitute over top. To make topping, mix remaining ingredients except berries in a 1-quart glass container. Stir well. Cover with plastic wrap and microwave on high for 3 to 4 minutes, stirring often, until thick. Add berries and microwave on high for 3 to 4 minutes longer or until skins pop. Pour over pie. Chill.

Renal and Renal Diabetic Exchanges:

1 Medium Potassium

Fruit

3 Fat

Analysis:

174

Calories 220

Carbohydrates 11

Protein 36

Fat 75

Sodium 176 75

Potassium 75

Phosphorus 58

Disclaimer: The author of the book does not take ownership of the recipes on this book. These are mainly to help supplement the kidney diet specified herein.

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