“My sister won’t let me have anything I want to eat,” said Mr. G during his primary care clinic visit. In his late fifties, Mr. G had suffered a stroke that had taken a toll on his memory. His sister had stepped in to help.
“Like what?” I asked.
“Like burritos.”
“Why not?”
“Because of my kidney failure.”
I did a little what you talkin’ ‘bout Willis pout, as I didn’t remember him as having kidney failure.
I looked back at his labs and was reassured. His estimated glomerular filtration rate or eGFR was around 50, what I would call a smidge of chronic kidney disease, or “moderate” in medical lingo. Whatever one chooses to call it, it is definitely not bad enough to warrant cutting burritos out of one’s life.
I explained this to Mr. G and wrote it down on his After Visit Summary. I don’t know if he forgot and lost the paper, but his sister came with him the next time I saw him.
“Well, that’s what they said when he was in the hospital,” she explained.
Inexcusable, but not surprising. Diet and nutrition have never been a significant focus of medical training, even though “what should I eat” has got to be in the top five frequently asked questions anybody facing any chronic medical condition has ever asked.
They were wrong, I explained back. Cutting burritos—and lots of other tasty foods high in potassium and phosphorus out of one’s diet (or at least drastically limiting them) is part of the Renal Diet and is only necessary when the kidneys can’t filter these electrolytes out of the bloodstream fast enough to avoid serious problems. This usually doesn’t happen until well below an eGFR of 30. All Mr. G needed to do was eat a diet that helped control his high blood pressure, so high blood pressure wouldn’t continue to damage his kidneys.
I discuss this and more in my latest installation of Real Kidney Talk with The People’s Nephrologist:
“So, I can get a burrito after we leave here?” Mr. G asked, smiling.
“Yes you can,” I said, smiling back.