The kidney

The purpose of the chapter is to offer a review of the physiopathology of kidney diseases related to multiple nutritional factors. These include not only protein and phosphate intake, but also dietary fats, excessive energy intake, nutrients related to hypertension, including sodium, alcohol and excess calories, bearing a negative impact and potassium, with a protective action. Metabolic disorders, such as dyslipidemia, obesity and a diabetes mellitus and low physical activity all have a role. Obesity is an independent risk factor for both chronic kidney and diabetic kidney diseases (obesity related glomerulopathy, ORG). Predialysis medical nutrition therapy has a role in delaying progression to stage 5 of kidney failure and in decreasing mortality after initiation of renal replacement therapy. Protein energy malnutrition and the inflammatory processes are frequent before and during dialysis. Kidney transplant is associated with metabolic complications. In the chapter current recommendations for screening, diagnosis, and treatment of clinically relevant nutritional problems are critically reviewed for application in clinical practice.