A 60-year-old man with a history of ischemic heart disease (he suffered an acute myocardial infarction in 2004) and was a former smoker.
The patient had no known allergies to medications or food.
In July 2008, she was diagnosed with primary amyloidosis and nephrotic syndrome.
At hospital discharge he received nutritional recommendations from the Nephrology Department to perform a low-sodium and fat diet, as well as to exclude protein foods.
To do so, the patient was required to cook all foods, not to use table salt, and could not use any other culinary technique (cold, flat, roasted, microwave, etc.), and not eat.
The current pharmacological treatment includes enalapril, candesartán, atorvastatin, acetylsalicylic acid, ezetimibe, atorvastatin, barniquine, and NSAID.
Go to the diet therapy clinic to prescribe a diet adjusted to your nutritional needs.
In the initial consultation a nutritional history was carried out including a complete anthropometric, biochemical and analysis of intake through a 3-day dietary survey analyzed with the Dietsource 3.0®Nestlé Healthcare Nutrition (Edicion 2005).
The characteristics of basal intake are shown in Table I, along with nutritional recommendations for the patient with nephrotic syndrome: protein-restricted diet, salt and lipid profile rich in monounsaturated and polyunsaturated fatty acids.
The initial examination yielded the following results:
1.
• Antrop: weight 86.7 kg, height 171 cm, BMI 29.65 kg/m2.
Body composition was measured by bioelectrical impedance analysis (TANITA TBF): 56.4% fat mass ® 300.6%), 76.6 kg lean body mass (88.4%) and 10.1 kg (88.4%).
The patient had edema with fovea up to the knees.
• Analytical Protein: Creatinine: 0.95 (normal values 0.5-1.1) mg/dL, abnormal Glomerular test: > 3.6 ml/min), negative controls (m.2, P: 2.431 g normal
Albumin: 1.74 (normal values 3.5-5) gr/dL and prealbumin: 20 (normal values 10) g/dL.
Proteinuria: 14.55 g/24 h.
Total cholesterol: 180 (normal values 100-200) mg/dL, triglycerides: 110 (normal values 50-150) mg/dL, HDL: 44 conscious mg/dL (23 normal values 40-65 LDL),
A diet was prepared according to recommendations3, according to patient characteristics, tastes, customs and schedules.
Table I shows the nutritional characteristics of the diet and Table II shows the patient's diet.
1.
After six months of dieting, the patient presented the following data:
Antrop: weight 79.4 kg, BMI 27.15 kg/m2.
The body composition measured with the same technique as in the initial visit indicated 46.5 % of water (58.6%), 63.5 kg of lean mass and 15.9 kg of fat mass (20.6%).
The edemas had decreased and were present only in the perimaleolar area.
Analytical: Creatinine: 1.58 mg/100, prescribed Glomerular Cretinine: 48 ml/min/mixed m2.
P: 4.4 mg/dL and K: 5.37 mmol/L. Total proteins: 4.8 g/L, albumin: 3.15 mg/dL and prealbumin: 36.9 mg/dL.
Proteinuria: 2.1 g/24 h.
Total cholesterol: 140 mg/dL, triglycerides: 88 mg/dL, HDL: 64 mg/dL, LDL: 58.4 mg/dL, Acid: 10.75 mg/dL.
Adherence to diet: Dietary intake was assessed using a 24-hour recall and analyzed with the same software as in the initial visit.
The data are shown in Table I.
At present, the patient continues with the diet and continues to attend the diet therapy consultation bimonthly.
