Ch. 28 Renal Diseases

Question 1

Which fat-soluble vitamin is activated by the kidneys?

Answer 1

Vitamin D

Question 2

Kidneys

Answer 2

Help maintain chemical, fluid, and acid-bases (pH) balances and assists in blood pressure regulation; RBC production, and the activation of vitamin D

Question 3

Ureter

Answer 3

Conducts urine from the kidneys to the bladder

Question 4

Bladder

Answer 4

Stores urine until it can be excreted

Question 5

Urethra

Answer 5

Transports urine from the bladder to outside the body

Question 6

Renal Artery

Answer 6

Carries blood from the heart to the kidneys

Question 7

Renal Vein

Answer 7

Carries blood from the kidneys back to the heart

Question 8

What are functions of the kidneys (9)?

Answer 8

1. Eliminate fluids
2. Reabsorb fluids
3. Maintain acid-base balance (pH balance)
4. Maintain electrolyte balance
5. Regulates BP
6. Stimulate RBC production
7. Maintain bone structure
8. Formation of urine

Question 9

Chronic Kidney Disease (CKD)

Answer 9

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%)

Question 10

Symptoms of CKD may not appear until ____% of renal function is lost.

Answer 10

75%

Question 11

Most common cause of CKD is ____ ____ (____%).

Answer 11

Diabetes Mellitus; 45%

Question 12

CKD: Risk Factors

Answer 12

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

Question 13

CKD: Consequences

Answer 13

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

Question 14

CKD Consequences: Increased Blood Urea Nitrogen (BUN), Creatinine, Uric Acid

Answer 14

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]

Question 15

CKD Consequences: Increased Phosphorus and Potassium

Answer 15

Elevated potassium: nausea, fatigue, slows pulse, can be deadly –> kidneys can’t excrete these

Question 16

CKD Consequences: Decreased Calcium

Answer 16

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)

Question 17

CKD Consequences: Anemia

Answer 17

Erythropoietin: hormone needed to make hemoglobin (in RBCs)

–in CKD you can see decreased erythropoietin synthesis

Question 18

CKD Consequences: Uremia

Answer 18

Abnormal accumulation of nitrogen containing substances

S and S: headaches, fatigue, confusion, GI symptoms

*Uremia can also come into play with GI disturbances

Question 19

CKD: Consequence: PRO-E Malnutrition

Answer 19

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

Question 20

Treatment: Example - Hemodialysis

Answer 20

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

Question 21

Discuss protein intake in a healthy person vs that in a person on a pre-dialysis restriction.

Answer 21

healthy person: 0.8-1.0 g/kg of protein

pre-dialysis restriction: 0.60-0.75 g/kg of protein

Question 22

Which is more restrictive: hemodialysis or pre-dialysis? Why?

Answer 22

Pre-dialysis is more restrictive because kidneys are failing

Question 23

Acute Renal Failure causes

Answer 23

Consequence of severe illness, injury, or surgery