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Copyright 2014. KidneyDietSecrets.com

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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.

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

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

Vegetables..............................................................................................................................140
Breads......................................................................................................................................147
Desserts...................................................................................................................................154
Disclaimer...............................................................................................................................174

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.

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

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

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 nowa 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 wasnt
until my anatomy and physiology class in nursing school that I found out I wasnt 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. Scarlike 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.

19

Kidney Disease Prevention Tip #9: Reduce your salt and fat intake.
Kidney Disease Prevention Tip #10: Visit your physician regularly.

20

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.
21

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.

22

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.

23

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.

24

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 adequatelylow 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

25

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.

26

Figure 5.1: The Hemodialysis Cycle

Needle Insertion Techniques
Most hemodialysis sessions require needle insertion. Most dialysis
centers use two needlesone 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

27

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

28

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.

29

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

30

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.

31

 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).

32

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

33

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.

34

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.

35

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.

36

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

37

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
38

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.

39

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.

40

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

41

(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)
42

 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

43

 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 postischemic (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

44

(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

45

 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

46

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

47

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

48

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.

49

 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

50

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.

51

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.

52

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.
53

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???

54

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.
55

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.

56

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.

57

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.

58

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
_____ eggs
_____ cottage cheese
_____ ice cream
_____ tuna
_____ pork
frozen
milk
_____
_____
_____ fish
yogurt
turkey
_____ chicken
_____ hotdogs
_____ 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?

59

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
cup tuna or salmon
cup pudding, custard, or ice cream
1 piece egg
cup dried beans and peas
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).

60

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
cup macaroni and cheese = 1 servings = 12 grams protein
1 hotdog (1 oz) = 1 servings = 12 grams protein
1 chicken drumstick (1 oz) = 1 servings = 12 grams protein
3 by 3 fish fillet (3 oz) = 3 servings = 24 grams protein
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

61

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 cup or 1 slice;
For small bagels and english muffins, of it = 1 serving.)
_____ cold cereals
_____ cookies
_____ bread
_____ croutons
_____ animal crackers
_____ pita bread
_____ tortillas
_____ potatoes
_____ popcorn
_____ muffins
_____ noodles
_____ saltines
_____ yams
_____ rice
_____ rolls
_____ hot cereals
_____ cakes
_____ bagels
_____ corn
B. Vegetables (generally contain about 1 gram protein per cup serving)
_____ brocolli
_____ vegetable juices
_____ spinach
_____ green beans/peas
_____ cabbage
_____ lettuce
_____ cauliflower
_____ radishes
_____ squash
_____ carrots
_____ mushrooms
_____ asparagus
C. Fruits ( cup of fruit has trace amounts of protein.)

62

_____ apples
_____ raisins
_____ grapes

_____ fruit cocktail

_____ peaches
_____ fruit juices
_____ oranges
_____ apricots

_____ cherries
_____ melon
_____ kiwis
_____ pears
_____ berries

_____ tomatoes
_____ bananas
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.

63

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.

65

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
66

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
67

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 days 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
68

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-Lovers 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 Nioise* 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
69

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
70

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*
71

1/2 cup
Sunshine Carrots* 1/2 cup
Dinner Roll 1
Margarine 2 teaspoons
Red Hot Jello Salad*
2/3 cup

72

Appetizers and Snacks

74

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 300F. 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

75

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
ilk1
Fat

Analysis:
Calories 134
Carbohydrates 13
Protein 3
Fat 8
Sodium 88
Potassium 159
Phosphorus 53

76

Onion Bagel Chips

Ingredients:
2
3
-1/2oz
plain
bagels
2
tablesp
oons
margar
ine,
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 325F 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

77

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 350F. 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

78

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

79

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
80

Protein 8
Fat 3
Sodium 49
Potassium 187
Phosphorus 72

81

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 350F 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

82

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 350F oven for 710 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

83

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

84

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 saut 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 375F 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
85

Fat 6
Sodium 38
Potassium 98
Phosphorus 44

86

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

87

Breakfasts

88

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 450F 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
89

Carbohydrates 51
Protein 13
Fat 31
Sodium 525
Potassium 311
Phosphorus 393

90

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

91

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

92

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, saut 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
93

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, saut 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 375F
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
Exhanges:

Diabetic

1 Starch, 1 Medium
Potassium Vegetable,
2 Fat

Analysis:
Calories 201
Carbohydrates 14
Protein 5
Fat 14
Sodium 222
94

Potassium 163
Phosphorus 50

95

Soups and Salads

96

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

97

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

98

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
99

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

100

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
101

Cream of Corn Soup

Ingredients: 2
tablespoons margarine
2 tablespoons flour
1/8 teaspoon pepper
1 cup water
1
cup liquid nondairycreamer
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

102

Cream of Crab Soup

Ingredients:
1 tablespoon
unsaltedmargarine
1/2 medium onion, chopped
1/2 lb imitation crabmeat,
shredded 1 quart lowsodium 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

103

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

104

Pasta Salad Nioise

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 7-3/4oz 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

105

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

106

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

107

Meat, Chicken and Seafood

Entrees

108

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 400F. 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

109

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

110

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
111

Vegetable
1 Fat

112

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. Saut 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

113

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

114

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

115

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
Exchanges:

Diabetic

3 Meat, 2 Low
Potassium Vegetable

Analysis:
Calories 201
Carbohydrates 12
Protein 25
Fat 6
Sodium 196
Potassium 484
Phosphorus 247

116

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 350F 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

117

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
118

Sodium 72
Potassium 306
Phosphorus 181

119

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
350F. 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

120

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

121

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 425F. 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

122

Pork With Julienne Vegetables

Ingredients:
4 pork cutlets, 4 oz each
(1/2-inch thick)
2 tablespoons flour
1/2 teaspoon saltfree 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
123

Fat 32
Sodium 130
Potassium 388
Phosphorus 218

124

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 400F 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
125

Analysis:
Calories 201
Carbohydrates 19
Protein 11
Fat 9
Sodium 75
Potassium 176
Phosphorus 115

126

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
Exchanges:

Diabetic

2 Meat, 1 Starch, 1
Low Potassium Fruit

Analysis:
Calories 208
Carbohydrates 26
Protein 15
Fat 5
Sodium 86
Potassium 189
Phosphorus 167

127

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 lowsodiumchicken 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

128

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
129

Fat 9
Sodium 157
Potassium 427
Phosphorus 192

130

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

131

Rice, Pasta, Stuffing

132

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

133

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 lowcholesterol 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

134

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 350F. 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

135

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 325F 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

136

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:
Saut 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

137

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

138

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

139

Vegetables

140

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 350F. 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

141

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

142

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 350F 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

143

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. Saut 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

144

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

145

Summer Vegetable Saut

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 saut 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

146

Breads

147

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
St
arch2
Fat

Analysis:
Calories 175
Carbohydrates 14
Protein 3
Fat 12
Sodium 153
Potassium 38
Phosphorus 31

148

Gingerbread
Ingredients:
2
te
aspoons
lemon
juice
orvinega
r 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
350F 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
149

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 350F 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

150

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 375F. 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

151

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 425F 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

152

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 375F 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

153

Desserts

154

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 350F. 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:
155

Calories 335
Carbohydrates 66
Protein 4
Fat 6
Sodium 172
Potassium 111
Phosphorus 93

156

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 325F 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

157

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 350F 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

158

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 450F for 15 minutes. Reduce heat to
375F 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

159

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 400F for 10 to 12 minutes, until cookies are golden
brown around edges.

Renal Exchanges:
1 Starch
1 Fat

Renal
Exchanges:

Diabetic

1 Starch, 2 Fat

Analysis:
Calories 158
Carbohydrates 20
Protein 2
Fat 8
Sodium 99
Potassium 18
Phosphorus 17

160

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 375F.

Renal
and
Renal
Diabetic Exchanges:
1
St
arch1
Fat

Analysis:
Calories 99
Carbohydrates 8
Protein 1.4
Fat 7
Sodium 98
Potassium 28
Phosphorus 19

161

Chocolate-Lovers Mousse
Ingredients:
2
ta
blespoon
s
sugar1/2
teaspoon
unflavor
ed
gelatin
1/4 cup
milk 1/2
cup
semisweet
chocolat
e
minichip
s1
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
162

Analysis:
Calories 487
Carbohydrates 40
Protein 5.5
Fat 38
Sodium 46
Potassium 242
Phosphorus 111

163

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 400F 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

164

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 375F. 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

165

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 350F 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

166

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

167

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

168

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 425F 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
Exchanges:

Diabetic

1 Starch, 1 Medium
Potassium Fruit, 1 Fat

Analysis:
Calories 153
Carbohydrates 24
Protein 3
Fat 5
Sodium 167
Potassium 19

169

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

170

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 350F.
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
171

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

172

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 lowcholesterol 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:
173

Calories 220
Carbohydrates 11
Protein
Fat
Sodium 176
Potassium

36
75
75
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.

174

172