Ch 29: Renal Disease

Question 1

What is usually accepted as best overall index of kidney function?

Answer 1

GFR

Question 2

What is an AKI?

Answer 2

Defined as abrupt decline in kidney function over hours to days that leads to reduction of both glomerular filtration and tubular function; Clinically, diagnosis/severity of AKI are determined by observing rise in serum creatinine often in association with decreased urine output

Question 3

What are the most common causes for AKI in hospitalized patients?

Answer 3

A combination of events including sepsis, hypotension, and exposure to nephrotoxic and therapeutic agents

Question 4

How is CKD defined?

Answer 4

CKD is defined as abnormalities of kidney structure of function present for > 3 months with implication for health; CKD is classified based on estimated GFR and albuminuria

Question 5

Why are CKD patients prone to anemia?

Answer 5

Decreased EPO synthesis, decrease in erythrocyte life span, and nutrient deficiencies (particularly iron)

Question 6

When would CRRT be used?

Answer 6

For patients in ICU w/ tenuous hemodynamics and inability to tolerate large volume shifts, CRRT can be used due to its slower/gentler rate of solute or fluid removal

Question 7

Which electrolyte imbalance is common in PD?

Answer 7

Hypokalemia can occur on occasion b/c most commercially available solutions do not contain potassium

Question 8

What are the advantages and disadvantages of PD?

Answer 8

Advantages: reduced diet restrictions b/c waste products are constantly filtered, can be done at home,

Disadvantages: Can provide a significant amount of glucose, pt’’s more prone to peritonitis

Question 9

What is the only screening tool recommended for nutrition assessment of (non ICU) CKD patients?

Answer 9

SGA

Question 10

When should adjusted body weight be used?

Answer 10

For patients who weigh more than 120% of their IBW

Question 11

How are anuria and oliguria defined?

Answer 11

Anuria: < 50 mL of UOP
Oliguria: UOP > 50 mL but < 500 mL/day

Question 12

In CKD, total amount of elemental Ca should not exceed what?

Answer 12

2000 mg/day which includes nutrition intake and meds such as calcium-based binders

Question 13

What is phosphorus generally restricted to in CKD?

Answer 13

800-1200 mg/day

Question 14

What metabolic abnormality happens in AKI and CKD due to loss of normal acid excretion or loss of bicarbonate?

Answer 14

Acidosis

Question 15

Which labs should be monitored to assess iron status in CKD?

Answer 15

Iron status should be assessed by measuring serum iron, TIBC, iron saturation , and ferritin

Question 16

Which lab is a measurement of body iron stores?

Answer 16

Ferritin

Question 17

What are the protein/energy requirements for non dialysis CKD and HD patietns?

Answer 17

30-35 kcal/kg (for both)
Non dialysis protein: 0.6-0.8 g/kg/day

Dialysis protein: >1.2 g/kg/day

Question 18

What are the protein/energy requirements for PD patients and CRRT patients?

Answer 18

30-35 kcal/kg (for both); consider any energy provided from dialysate

Question 19

What are the kcal/protein needs for AKI?

Answer 19

20-30 kcal/kg/day

0. 8-1.0 g/kg/day (not on dialysis)
1. 0-1.5 g/kg/day (if on RRT)

Question 20

Which electrolyte may become low in PD?

Answer 20

Potassium—most commercially available PD solutions do not contain potassium

Question 21

What is the accumulation of BUN referred as?

Answer 21

Azotemia

Question 22

What is the glomerular filtration rate (GFR) of a patient with end-stage renal disease?

Answer 22

<15 mL/min/1.73 m2

Stage 1, Kidney damage with normal or high GFR: >90 mL/minute/1.73 m2.
Stage 2, Kidney damage with mild low GFR: 60-89 mL/minute/1.73 m2.
Stage 3, Moderate low GFR: 30-59 mL/minute/1.73 m2. Stage 4, Severe low GFR: 15-29 mL/minute/1.73 m2.
Stage 5, Kidney failure: <15 (or dialysis) mL/minute/1.73 m2.

Question 23

What is the recommended maximum dietary protein intake in critically ill adult patients receiving continuous renal replacement therapy (CRRT)?

Answer 23

2.5 g/kg/day

Question 24

What are the protein requirements for a stable patient receiving peritoneal dialysis (PD)?

Answer 24

1.2-1.3 grams per kilogram per day