Ch. 23 Kidneys Flashcards
Functions of kidneys?
- Regulate: Fluid, electrolytes, acid-base
- Secrete renin: regulates B.P.
- Produce erythropoietin: Stimulates RBC prod. in bone marrow
- Convert Vit. D to active form: Regulates Ca levels
Characteristics of AKI?
- Kidney function deteriorate rapidly
- Decreased urine output
- Altered blood composition
- Can be reversible but could also lead to CKD
Cause locations of AKI?
- pre renal
- intra renal
- post renal
Pre renal injury and examples?
Sudden reduction in blood flow to kidneys
- low blood volume
- Renal artery disorders
- Heart disorders
Intra renal injury and examples?
Things that damage kidney tissue
- Vascular disorders: DM, Sickle cell, Transfusion
- Obstructions within: Tumors, scar tissue, stones
- Renal injury: infection, drugs, e. coli
Post renal injury and examples?
Things that affect urine excretion
- obstructions: strictures, tumors, stones
- Bladder disorders: rupture, nerves
- Pregnancy
Labs for Kidney disease?
- BUN: Blood urea nitrogen-Elevated
- CR: Creatinine- Elevated
- UA: Uric acid- Elevated
- GFR: Glomerular Filtration Rate- Decreased
The following cards are consequences of AKI…
- Oliguria
- Anuria
- Inadequate waste filtering
- Edema
- Uremia
- Uremic Syndrome
- Metabolic alterations
Oliguria
Really low production of urine
Anuria
No urine production
Inadequate waste filtering
Hyperkalemia, hyperphosphatemia, hypernatremia, hypermagnesemia in blood.
Edema
Fluid collection in face, hands, feet, ankles because of high sodium levels.
Uremia
High nitrogen containing compounds in the blood
Uremic Syndrome
.
Metabolic alterations
Extracellular fluid protein catabolism Amino acid metabolism Insulin resistance reduction of lipolysis depletion of antioxidant system induce inflammation Immunodeficient
Goals for treatment of AKI?
- Individualized
- Restore fluid and electrolytes
- Minimize waste products in blood
-Can include both medical and nutrition management
Medical management of AKI?
- Treat underlying symptoms: problem may correct itself
- Manage symptoms
- Drug therapy: Diuretics, reduce doses of meds if no dialysis, potassium and phosphate binders
- Dialysis: Will need to increase doses of medications
Nutrition therapy for AKI in following cards
- Energy
- Protein
- Fluids
- Electrolytes
Energy
25-35 kcal/kg dry body weight
Monitor body weight over time to be sure intake is adequate
Protein
- No dialysis: 0.8-1.0 g/kg dry body weight/day
- Dialysis: 1.0-1.7 g/kg dbw/day
Fluids
- 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
Electrolytes
*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
Characteristics of CKD?
- Gradual, irreversible kidney damage
- Progresses over many years, usually w/o symptoms
- Caused by: DM, Uncontrolled hypertension, genetics, inflammation, and immunological disorders
What is going on in the kidneys with CKD?
Nephrons enlarge to handles excess load
Enlargement causes deterioration of nephrons
More and more nephrons fail over time
How to test for CKD?
GFR: rate at which kidney forms filtrate
What GFR value indicates stage 5 kidney failure/ESRD?
Less than 15
Early stage(1-3) symptoms of CKD?
- Anorexia
- Fatigue
- Headache
- Hypertension
- Proteinuria: protein in urine
- Hematuria: blood in urine
Advanced stage(3-5) symptoms of CKD?
Anemia CVD Confusion Fluid and Electrolyte imbalance Hormonal abnormalities PEM Peripheral neuropathy Lowered immune function
Uremic Syndrome-Stage 5
-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
Medical treatment for CKD?
- Dialysis if GFR is low
- Medications to manage symptoms
Surgery to widen vein by connecting it to artery?
Arteriovenous fistula procedure
Nutrition therapy for CKD in following slides..
Energy Protein Lipids What to restrict? Iron Renal vitamin
Energy
30-35 kcal/kg/day
Protein
- Pre-dialysis: 0.6-0.75 g/kg
- Dialysis: 1.2-1.4 g/kg
Lipids
Restrict SFA, trans fats, and cholesterol
Restrict the following?
Fluids
Sodium
Potassium
Phosphorus
Iron is given intravenously
Also renal multivitamin may be necessary
.
How to comply with renal diet Fluid restriction?
- Gum, or suck hard candy
- suck on frozen grapes
- Freeze beverages: take longer to consume
- Gargle refrigerated mouth wash
How to comply with renal diet by increasing calories?
- Margarine or flavored oil
- Extra salad dressing and mayo
- non-dairy whipped topping
- Fried foods
Compliance with renal diet and Lowering potassium?
- 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
Compliance by decreasing monotony?
- Non dairy milk products
- spices
- occasional use of restricted foods
