SUMMARY
The kidneys find difficulty in eliminating certain substances, namely, the end-products of protein metabolism—urea, water, salts, and purin bodies.
The Urine constitutes the chief point of investigation. Analysis shows the presence of albumen, casts, blood cells, and pigments, with a corresponding deficiency in the normal constituents, water, urea, and salts.
Volume of Urine.—The volume of urine is reduced, and at times suppressed, owing to the difficulty with which the kidneys eliminate water in nephritic conditions.
The Blood shows the presence of the toxic substances on account of the inability of the kidneys to eliminate them properly.
Edema is a common symptom and is probably due to the retention of salts and water by the tissues of the body. It is treated and at times relieved by limiting the intake of fluids and reducing the amount of sodium chloride in the diet.
Uremia is the most dreaded symptom and develops as a result of the retained toxins in the blood. Its development is prevented, if possible, by reducing the amount of fluid and food, even of milk, in the diet.
Uremic Poisoning is an acute intoxication due to the abnormal retention of these poisons and the inability of the kidneys to eliminate them. It is combated by instituting a starvation treatment which is followed by the above-mentioned restricted diet.
Gastro-intestinal Disturbances, especially diarrhea, are apt to develop in chronic nephritis. Care must be taken to keep the meals small in size, simple in proportion, and constituted only from the allowed foods.
Anemia follows the acute attack and is especially noticeable in those cases in which a rigid starvation régime has been found necessary. It may likewise be the result of a long-continued diet in which the proteins have been reduced to the lowest possible amount. The simple proteins in the diet must, at times, be increased and the patient advised to take plenty of fresh air and sunshine, in order to overcome this progressive anemia.
Restrictions in the diet are essential. These consist of limiting the amount of food and fluids as well as the type of food ingested.
Restricting the Proteins.—Proteins are restricted on account of the difficulty with which the end-products are eliminated by the kidneys, also on account of the toxic character of these substances.
Restricting the Fluids.—It is necessary, on account of their difficulty of elimination and because they impose an excessive tax upon the circulatory organs.
Treatment is largely dietetic in character by reason of the advantages just mentioned.
Starvation Treatment is instituted in order that the work of the kidneys may be lessened. This treatment consists of abstinence from food with a definite reduction in the fluid intake. It is found to be necessary during the acute stage of the disease.
Extreme Thirst, which is apt to be an annoying symptom at this time, is relieved, as far as possible, with small sips of water or ice pellets held in the mouth.
Nephritic Cures are devised, as far as possible, to relieve the acute symptoms and to prevent the disease from developing into a chronic condition. Milk is the basis of most of these cures. It is given in definite amounts at stated intervals; the quantity and frequency with which it is given being adjusted to the state of the disease and the condition of the patient.
The Karell Cure is one of the best known diet cures used in the relief of acute nephritis. It consists of the giving of skimmed milk three or four times a day in doses ranging from three to six ounces for one week, at the end of which time, provided the stools remain solid, an increase to two quarts a day is made.
Constipation under the circumstances is a favorable symptom, indicating as it does the agreement of the milk.
Diarrhea as a result of gastro-intestinal disturbances has directly the opposite indication. In these cases the milk must be reduced. Karell advises the boiling of milk and relieving the constipation by means of mild laxatives or enemas.
Duration of the Karell Cure is from four to six weeks, after which a gradual return to a normal diet is made.
Hunger is apt to be prominent at this stage of the treatment and is relieved during the second or third week by giving a small piece of dry bread and milk, soup thickened with a cereal, once a day.
Functional Kidney Tests are made to determine the character and extent of the impairment of the functions of the kidneys. The diets used in these tests contain definite amounts of certain diuretic substances, and the analysis of the urine voided during the twenty-four-hour period required by the test shows the nature of the impairment and furnishes, in a measure, a means of determining the amount of food and fluid which is safe for the patient to take. It likewise shows the extent to which the restrictions in the salt and proteins are necessary.
Salt-free, or Salt-poor Diets are necessary in some cases. While restriction in the amount of salt used in the preparation of food for the nephritic patient is always advisable, if there is a tendency to edema, the salt shaker should be left off the tray, and when there is a definite amount of salt prescribed, it should be weighed or measured for the day rather than for the meal, and the amount consumed recorded after each feeding.
Special Points for the nurse to remember are the necessity for an early recognition of unfavorable symptoms—of instructing the patient upon leaving her care in the need for keeping the size of the meals small;—of the danger of indulging in alcoholic or other stimulating beverages;—of eating highly spiced foods, or of eating anything which may cause gastro-intestinal disorders.
She should emphasize the need for regular examination of the urine and the value of rest and freedom from nervous excitement, and the need of living in the sunshine as much as possible.
The nurse should study the diet list and become familiar with the foods allowed and those to be avoided. The tables show the foods which are rich in salts and proteins. She should likewise understand and be able to make the simple test for albumen in the urine and the method of collecting the urine for the test made in the laboratory.