Ch. 28 Renal Diseases Flashcards
Which fat-soluble vitamin is activated by the kidneys?
Vitamin D
Kidneys
Help maintain chemical, fluid, and acid-bases (pH) balances and assists in blood pressure regulation; RBC production, and the activation of vitamin D
Ureter
Conducts urine from the kidneys to the bladder
Bladder
Stores urine until it can be excreted
Urethra
Transports urine from the bladder to outside the body
Renal Artery
Carries blood from the heart to the kidneys
Renal Vein
Carries blood from the kidneys back to the heart
What are functions of the kidneys (9)?
- Eliminate fluids
- Reabsorb fluids
- Maintain acid-base balance (pH balance)
- Maintain electrolyte balance
- Regulates BP
- Stimulate RBC production
- Maintain bone structure
- Formation of urine
Chronic Kidney Disease (CKD)
Characterized by gradual, irreversible deterioration of the kidneys. Also called chronic renal failure.
Typically diagnosed late in the course of illness, after most kidney function has been lost.
Generally progresses over many years w/o causing symptoms
Most common cause: DM (45%)
Symptoms of CKD may not appear until ____% of renal function is lost.
75%
Most common cause of CKD is ____ ____ (____%).
Diabetes Mellitus; 45%
CKD: Risk Factors
Diabetes HTN (because of impacted blood flow) Heart disease Smoking Obesity High cholesterol Family history of kidney disease Age (65+) Populations at risk: --African Americans, Native Americans, Asian Americans
CKD: Consequences
Blood chemistry alterations
- -increased blood urea nitrogen (BUN), creatinine, uric acid
- -increased phosphorus and potassium
- -decreased calcium
- -cardiovascular complications
- -GI disturbances (nausea, vomiting)
- -growth failure and wasting syndrome
- -anemia
- -uremia
CKD Consequences: Increased Blood Urea Nitrogen (BUN), Creatinine, Uric Acid
Think about protein with all 3 of these and whether or not we’re going to restrict protein
BUN and creatinine are end products of protein metabolism
Uric Acid: end product of purine metabolism and protein foods are rich in sources of purses (meat, fish, poultry) [this is extremely important]
CKD Consequences: Increased Phosphorus and Potassium
Elevated potassium: nausea, fatigue, slows pulse, can be deadly –> kidneys can’t excrete these
CKD Consequences: Decreased Calcium
Normal [healthy person]: decreased blood calcium –> vitamin D is going to help raise and promote absorption of calcium in the intestines
Kidney Failure: less vitamin D available –> decreased calcium absorption
Dietary restrictions of CKD can also lead to restrictions on certain foods which decrease calcium absorption/intake
–restrict phosphorus foods (which are high in calcium…like milk)
CKD Consequences: Anemia
Erythropoietin: hormone needed to make hemoglobin (in RBCs)
–in CKD you can see decreased erythropoietin synthesis
CKD Consequences: Uremia
Abnormal accumulation of nitrogen containing substances
S and S: headaches, fatigue, confusion, GI symptoms
*Uremia can also come into play with GI disturbances
CKD: Consequence: PRO-E Malnutrition
PRO-E Malnutrition = protein-energy malnutrition
Anorexia
- -primary: poor dietary intake
- -secondary: nausea and vomiting, restrictive diets, uremia, medications
Nutrient losses: vomiting, diarrhea, restrictive diets can cause nutrient losses
Treatment: Example - Hemodialysis
Hemodialysis = blood is circulated through a dialyzer (artificial kidney), where it is bathed by dialysate, a solution that selectively removes fluid and wastes
–individual goes in a couple times a week for this treatment
Discuss protein intake in a healthy person vs that in a person on a pre-dialysis restriction.
healthy person: 0.8-1.0 g/kg of protein
pre-dialysis restriction: 0.60-0.75 g/kg of protein
Which is more restrictive: hemodialysis or pre-dialysis? Why?
Pre-dialysis is more restrictive because kidneys are failing
Acute Renal Failure causes
Consequence of severe illness, injury, or surgery
