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Diet Therapy > Ch. 23 Kidneys > Flashcards

Ch. 23 Kidneys Flashcards

1
Q

Functions of kidneys?

A
  1. Regulate: Fluid, electrolytes, acid-base
  2. Secrete renin: regulates B.P.
  3. Produce erythropoietin: Stimulates RBC prod. in bone marrow
  4. Convert Vit. D to active form: Regulates Ca levels
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2
Q

Characteristics of AKI?

A
  1. Kidney function deteriorate rapidly
  2. Decreased urine output
  3. Altered blood composition
  4. Can be reversible but could also lead to CKD
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3
Q

Cause locations of AKI?

A
  1. pre renal
  2. intra renal
  3. post renal
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4
Q

Pre renal injury and examples?

A

Sudden reduction in blood flow to kidneys

  1. low blood volume
  2. Renal artery disorders
  3. Heart disorders
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5
Q

Intra renal injury and examples?

A

Things that damage kidney tissue

  1. Vascular disorders: DM, Sickle cell, Transfusion
  2. Obstructions within: Tumors, scar tissue, stones
  3. Renal injury: infection, drugs, e. coli
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6
Q

Post renal injury and examples?

A

Things that affect urine excretion

  1. obstructions: strictures, tumors, stones
  2. Bladder disorders: rupture, nerves
  3. Pregnancy
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7
Q

Labs for Kidney disease?

A
  1. BUN: Blood urea nitrogen-Elevated
  2. CR: Creatinine- Elevated
  3. UA: Uric acid- Elevated
  4. GFR: Glomerular Filtration Rate- Decreased
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8
Q

The following cards are consequences of AKI…

A
  1. Oliguria
  2. Anuria
  3. Inadequate waste filtering
  4. Edema
  5. Uremia
  6. Uremic Syndrome
  7. Metabolic alterations
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9
Q

Oliguria

A

Really low production of urine

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10
Q

Anuria

A

No urine production

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11
Q

Inadequate waste filtering

A

Hyperkalemia, hyperphosphatemia, hypernatremia, hypermagnesemia in blood.

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12
Q

Edema

A

Fluid collection in face, hands, feet, ankles because of high sodium levels.

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13
Q

Uremia

A

High nitrogen containing compounds in the blood

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14
Q

Uremic Syndrome

A

.

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15
Q

Metabolic alterations

A 
Extracellular fluid
protein catabolism
Amino acid metabolism
Insulin resistance
reduction of lipolysis 
depletion of antioxidant system
induce inflammation
Immunodeficient
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16
Q

Goals for treatment of AKI?

A
  1. Individualized
  2. Restore fluid and electrolytes
  3. Minimize waste products in blood

-Can include both medical and nutrition management

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17
Q

Medical management of AKI?

A
  1. Treat underlying symptoms: problem may correct itself
  2. Manage symptoms
    - Drug therapy: Diuretics, reduce doses of meds if no dialysis, potassium and phosphate binders
    - Dialysis: Will need to increase doses of medications
18
Q

Nutrition therapy for AKI in following cards

A
  1. Energy
  2. Protein
  3. Fluids
  4. Electrolytes
19
Q

Energy

A

25-35 kcal/kg dry body weight

Monitor body weight over time to be sure intake is adequate

20
Q

Protein

A
  • No dialysis: 0.8-1.0 g/kg dry body weight/day

- Dialysis: 1.0-1.7 g/kg dbw/day

21
Q

Fluids

A
  • Assess status from weight differences, b.p., and a physical
  • Replace fluids to prevent dehydration: Urine output+500mL/day
  • Can assess adequacy of intake from blood sodium levels
  • Hyponatremic: excess fluid intake
  • Hypernatremic: inadequate fluid intake
22
Q

Electrolytes

A

*Only change if blood levels are out of range

Potassium: 2,000-3,000 mg/day
Sodium: 1,000-2,000 mg/day
Phosphorus: 8-15 mg/kg dbw/day

23
Q

Characteristics of CKD?

A
  1. Gradual, irreversible kidney damage
  2. Progresses over many years, usually w/o symptoms
  3. Caused by: DM, Uncontrolled hypertension, genetics, inflammation, and immunological disorders
24
Q

What is going on in the kidneys with CKD?

A

Nephrons enlarge to handles excess load
Enlargement causes deterioration of nephrons
More and more nephrons fail over time

25
Q

How to test for CKD?

A

GFR: rate at which kidney forms filtrate

26
Q

What GFR value indicates stage 5 kidney failure/ESRD?

A

Less than 15

27
Q

Early stage(1-3) symptoms of CKD?

A
  • Anorexia
  • Fatigue
  • Headache
  • Hypertension
  • Proteinuria: protein in urine
  • Hematuria: blood in urine
28
Q

Advanced stage(3-5) symptoms of CKD?

A 
Anemia
CVD
Confusion
Fluid and Electrolyte imbalance
Hormonal abnormalities
PEM
Peripheral neuropathy
Lowered immune function
29
Q

Uremic Syndrome-Stage 5

A

-Urine in blood
-Altered heart function. Caused by fluid and electrolyte imbalances causing hypertension which leads to arrhythmia which causes the heart to enlarge
-Neuromuscular disturbances: Altered thought, sleep disorders, muscle cramping, seizures
-Inadequate hormone levels
-Hormonal adaptation: Excess aldosterone released. Causes fluid overload and hypertension
Excess parathyroid hormone released. causes bone loss

30
Q

Medical treatment for CKD?

A
  • Dialysis if GFR is low

- Medications to manage symptoms

31
Q

Surgery to widen vein by connecting it to artery?

A

Arteriovenous fistula procedure

32
Q

Nutrition therapy for CKD in following slides..

A 
Energy
Protein
Lipids
What to restrict?
Iron
Renal vitamin
33
Q

Energy

A

30-35 kcal/kg/day

34
Q

Protein

A
  • Pre-dialysis: 0.6-0.75 g/kg

- Dialysis: 1.2-1.4 g/kg

35
Q

Lipids

A

Restrict SFA, trans fats, and cholesterol

36
Q

Restrict the following?

A

Fluids
Sodium
Potassium
Phosphorus

37
Q

Iron is given intravenously

Also renal multivitamin may be necessary

A

.

38
Q

How to comply with renal diet Fluid restriction?

A
  • Gum, or suck hard candy
  • suck on frozen grapes
  • Freeze beverages: take longer to consume
  • Gargle refrigerated mouth wash
39
Q

How to comply with renal diet by increasing calories?

A
  • Margarine or flavored oil
  • Extra salad dressing and mayo
  • non-dairy whipped topping
  • Fried foods
40
Q

Compliance with renal diet and Lowering potassium?

A
  • Cut veggies into 1/8 inch slices
  • rinse
  • soak in warm water 2 hours (10:1)
  • rinse
  • Boil in 5 parts water to 1 part vegetable
41
Q

Compliance by decreasing monotony?

A
  • Non dairy milk products
  • spices
  • occasional use of restricted foods

Diet Therapy (9 decks)

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