chapter 17 - kidney Flashcards
kidney function
excrete wastes
maintain volume and composition of body fluids
secrete certain hormones
fliter blood, cleanse it of waste products and recycyle other usable substances so necessary constituents of body fluids are consantly avaolaible
as filturate passes through nephrons it is concentated or dilutedto meet bodys nreeds (maintain compsition, bolume of body fluids, fluid balance, acid-base balance, and elecoytlye balance)
recycled materials like amino acids, glucose, minerals, vitamins, and water get reabsorbed
kidney cell parts
nephrons
nephron containsts glomerulus (filutring unit) which cintains specializaed capillaries
___L of ultrafiltrate is processed each date
180
how much urine is excreted daily
1.5L
what dowaste materials in urine containe
end products of protein metabolisms (urea, uric acid, creatinine, ammonia, and sulfates), excess water and nutrients, dead renal cells, and toxic substances
what is oliguria
when urine outpit is less than 500 ml/day
kidney are unable yo adeuately eliminate nitrogenous wate (end products of protein) can cause reanl failure
kidneys and vitamin synthesis
kidneys make final conversion of vitamin D, promoting absoprtion of calcium and metabolis of calcium and phosoprohoursou
kidneys indirectly stimualte bnoe marrow to reproduce RVC by proeucing erhytropoietin
etiology of renal failure
- infection
degeneratiove changes
diabetes mellitus
high bp
cysts
renal stones
truama (surgery, burns, poisons)
severe = renal failure
acute renal failure (ARF) occurs suddently and may last few days or few weeks, can be caused by another medical problem like serious burn, a crushing injury, or cardiac arrest
chronic kidney disease
slowly develops
causes number of functioning nephrons to diminish
renal tissue destoryed to point at which kidneys are no longer able to filtuer blood, excreete waste or ercycle nutrients as needed causing uremiaw
need dialysis or kidney transolant
what is uremia
protein wastes that should normally be excreted are instead cicumlating in blood
symptoms icnlude nausea, heache, convulsions, and coma
nephritis
inflammatory diseases of kidneys
caused by infection, degernative processes, or vascular disease
glomerulonephritis
inflammation affecting capillaries in glomeruli
may occur acutely in conjunctio nw another infection and be self limiting or may lead to serious renal deterioriate
stages of chronic idney disease `
1) kidney damage normal to icnrease function (90-130 GFR)
2) mild decrease in function (60-89 GFR)
3) Moderate decrease in function (30-59 GFR)
4) evere decrease in fucntion (15-29)
5) Kidney failure, defined as end-stage renal disease, dialusis usually iniatied (<15 GFR)
nephrosclerosis
hardening of renal arteria
caused by arteriosclerosis and hypertension
usually occurs in older ppl but sometimes in young diabetics
polycstic kidney disease
relatively rare, hereditary diease
cysts form and press on kidneys
kidneys enlarge and lose function
most people have normal kidney functions for many yuears, renal failure may develop near 50
nephrolithiasis
condition in which stones develop in kidneys
size of stones vary from grain of sand to much larger
sometimes asymptomatic bu could cause hematuria, infection obstru tion, and intense pain
what are kidney stones made from/ classiftion
based on compsition
calcium oxalate
uric acid
cystine
calcium phosphate
magnesium ammonium phospate (struvite)
dietary treatments of renal disease
- reuce amt of excretory work on kidneys
- sufficient protein (too mcuh could = uremia)
- restircted protein, sodium potassium phosphorous
- sufficient caloreis (primarily carb and fat, unsat fat)
- if energy required not met body tissue will be metabolised for energy
- 40g protein for predialysis
- 3 oz meat, fish or poultry and milk is not allowed or limited to 1/2 cup, grains are limited to 7 seervings, fruit is 5 servies, vegetables is 2 servings
calcium supplements, vitamin D, phosphorous to prevent ostemalacia
hyperkalamia in end stage renal disease (can cause cardiac arrest
increased need for vitamin B, C, and D
no vitamin A bc blood level of vitamin a elevated in uremia
vitmain k supplement if on antibiotics
iron bc anemia
hemodialysis
permanent accessto bloodstream through fistula (unusualy openings btwn 2 organs, near writst, and connect artery and vein)
3x a week for 3-5 hours each visit
peritoneal dialysis
peritoneal cavity as a semipermealbe mebrane
less efficient than hemodialyiss
treatment usually last about 10-12 hours a day 3x a week
cintunious anbulatory peritoneal dilausis (4/5 daily so 24 hour treatment)
diet on dialysis
additoinal protein
hemodialysis - 1.2 g protein per kg body weight
peritoneal dialysis - 1.2-1.3g protein per kg
CAPD - 1.2 g per kg
50% from high biological value (HB) prptein, which is found in eggs, meat, fish, poultry, milk and cheese
2000-4000kmg potassium if in renal failure
endstage renal failure is 1500-2500mg per day
renal diet: 80g protein - 3g sodium - 3g potassium
low potasisum foods (<150 mg/servings0
applesauce
berries
cranbbery sauce
grape syice
grapes
lemon or lime
mandarin oranges, canned
peaches, canned
pears, canned
plums, canned
rhubarb
bamboo shoots
bean sprouts
beans, green, wax, snap
broccoli
cabbage
cauliflower
corn, canned or small ear
cucumber
eggplant, cooked
hominy grits, cooked
leek
lettuce: cos, romaine, iceberg, leaf, endive, watercress
murshrooms
onion
peppers
radishes
rutabaga
summer squash turnips
water chestnuts
medium potassium
apple juice
apple raw
apricotrs, raw, canned
cherries, raw or cnned
grapefruit juice
grapefruit sections
mango
peach, raw, 1 medium
pear, raw, 1 medium
pineapple juice, raw or canned
pineapple spears
plums, raw, 2 medium
tangerine
asparagus
beets
brussel sprouts
carrots, cooking
celery
greens: collard, mustard, lake, dandelion, beet, turnips
mixed vegetables
okra
peas, green
pepper
summer squash: yellow crookneck, white scallop, zucchini
high potasisum food
avocado (1/2)
banans (1/2) dried frut
kiwi
melon
nectarine
orange
orange juice
papaya
prune juice
raisins
tangelo
artichoke
beet greens
dried beans and peas
potato
pumpkin spinach
sweet poatoes or yams
tomato (raw or cnaned)
unslated tomato juice
winter squash: acorn, butternut, hubbard sphagetti
sodium in ESR
3g sodium
equivalent of no-added-salt diet
luid contact in ESRD
fluid content of foods, other than liquids, is not counted in fluid restriction
diet after kidney tansplants
need for extra protein or restirction of protein
carb and soium may be resticted
approparte amts of these nutreints depend largely on med
additional calcium and phosphorous ay be necessary if there was substantial bone loss before transplant
dietary reatment of renal stones
large amoutns of fluids and wll-balanced diets
calcium oxalate stones
80% of renal sontes contian clacium oxalate
dietary intake of excessive animal protesin has been shown to be a risk factor for stone formation in some clients
stones containig oxalate are thought to be partially caused by diet esp rich in oxalate (found in beets, wheat bran, chocolat, tea, rhubarb, strawberries, spinach)
deficiency of pyridoxine, thiamine, magnesuim
uric acid stones
purine richfoods are restircted
purines are the end product of nuceloprotein metaboilsm and found in meats, fush and poultry
organ meats, anchovies, sardines, meat extracts, excessive alc and broths are esp rich sources of pruines
uric acid stones are usually associated w gout, GI diseases th acuase diarrhea and malignant sisease
medicaition will prevent gout and other complications y decreasing formation of uric acid
cystine stones
may form hen cystine concentration in urine becomes excessive bc heridarty metabolic disorder
usualy practice is increase fluids and alkaline-ash diet
struvite stones
magnesium ammonium phosphate
infection stones bc develop following urianry tract infeciton cased by certain microoragnism
low phosphorous diet is often rescribed
