more appropriate to their needs than the 1.15 grams per kilogram provided in their usual diet.3Sodium and Fluid: A limit on sodium of 1-3 grams per day is usually recommended to control edema and hypertension. Diuretics may also be used. A fluid restriction is not warranted unless renal failure occurs.Lipids: A diet low in saturated fat and cholesterol, combined with loss of excess weight, is recommended to reduce the risk of cardiovascular disease. Many clinicians recommend limiting cholesterol to less than 300 milligrams per day and fat intake to 30 percent of calories. However, research has shown that such recommendations lead to only minimal lipid lowering. As noted in detail in Section 1, low-fat vegetarian diets are much more effective for lipid control and usually lead to the reversal of atherosclerotic disease. Cholesterol-lowering drugs can be used adjunctively if needed.An eight-week trial in 13 men and 7 women with hyperlipidemia and nephrotic syndrome showed that a vegetarian diet significantly reduced cholesterol, triglycerides, and phosphorus.3Energy: Calorie intake should be adequate to achieve and maintain ideal body weight and maintain protein stores. Foods rich in complex carbohydrates should provide the majority of calories.Supplements: Patients with nephrotic syndrome are often low in B vitamins and zinc, and can benefit from supplements. In addition, since a significant portion of serum calcium is protein-bound, it tends to be low when serum proteins are reduced. No modification is routinely needed for potassium, but potassium losses due to secondary hyperaldosteronism may require replacement.4The following clinical values should be monitored:4Serum albumin and total proteinUrinary proteinGlomerular filtration rateDietary protein, fat, and cholesterolDaily weightsSerum lipidsAcute Renal FailureAcute renal failure, manifested by oliguria or anuria, usually occurs suddenly and is often reversible. It is marked by a reduction in the glomerular filtration rate and a modification in the kidneys ability to excrete metabolic wastes.Its causes can be prerenal, intrinsic, and postrenal. Prerenal causes include severe dehydration and circulatory collapse. Causes intrinsic to the kidney include acute tubular necrosis, nephrotoxicity, vascular disorders, and acute glomerulonephritis. Obstructive (postrenal) causes include benign prostatic hypertrophy and bladder or prostate cancer.1The most common form of intrinsic renal disease is acute tubular necrosis, accounting for about 75 percent of cases. Acute tubular necrosis may be due to posttraumatic or surgical shock or to the toxic effects of drugs, metals, or organic compounds.Nutrition strategies in acute tubular necrosis vary depending on its stage. During phase one, oliguria, less than 400 milliliters of urine is produced per day. This phase usually lasts one to three weeks. Signs and symptoms include nausea, vomiting, fluid overload, and elevation of BUN, creatinine, phosphorus, and potassium levels. Dialysis may be needed during this stage to reduce acidosis, control hyperkalemia, and correct uremia.The diuretic phase of acute tubular necrosis lasts one to two weeks, and is characterized by increased urine output and a return of the ability to eliminate wastes. Fluid and electrolyte balance should be monitored and replacements made as necessary. The convalescent phase occurs over the next two to six months.1,2Diet in Acute Renal FailureDiet plays a critical role in the care of patients