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clinical nutrition > Chapter 22 book notes > Flashcards

Chapter 22 book notes Flashcards

1
Q

As part of the urinary system, the kidneys are responsible for filtering the ??
and removing excess fluid and wastes for elimination in ??

A

-blood
-urine

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2
Q

One kidney contains how many nephrons?

A

-one million

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3
Q

nephron:

A

-the functional unit of the kidneys, consisting of a glomerulus and tubules.

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4
Q

filtrate:

A

-substances that pass through the glomerulus and travel through the nephron’s tubules, eventually forming urine.

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5
Q

glomerulus:

A

-a ball shape tuft of capillaries
-filters water and solutes from the blood as urine production begins

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6
Q

tubules:

A

-tubelike structures of the nephron that process filtrate during urine production.

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7
Q

Bowman’s capsule:

A

-a cuplike component of the nephron that surrounds the glomerulus and
collects the filtrate that is passed to the tubules.

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8
Q

As the filtrate moves through the tubules, its composition
continuously changes as some of its components are ?? and returned to the blood via ?? surrounding the tubules; the remaining substances contribute to the final ?? product.

A

-reabsorbed
-capillaries
-urine

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9
Q

By filtering the blood and forming urine, the kidneys regulate (3):

A

-volume and osmolarity,
-electrolyte concentrations,
-acid–base balance.

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10
Q

They also excrete metabolic waste products such as ?? and ?? , as well as various drugs and toxicants

A

-urea
-creatinine

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11
Q

Other roles of the kidneys include the following:

A

-Secretion of the enzyme renin, which helps to regulate blood pressure —
-Production of the hormone erythropoietin, which stimulates the production of red blood cells in the bone marrow
-Conversion of vitamin D to its active form, thereby helping to regulate calcium
balance and bone formation

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12
Q

nephrotic syndrome:

A

-a syndrome caused by significant urinary protein losses (more than 3 to 3½ grams daily),
-as a result of severe glomerular damage

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13
Q

Proteinuria can cause serious consequences including:

A

-edema,
-blood lipid abnormalities,
-blood coagulation disorders,
-infections

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14
Q

The average proteinuria is about ?? grams per day but may exceed ??grams daily in severe cases

A

-8
-30

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15
Q

The ?? attempts to compensate by increasing protein synthesis but is unable
to maintain normal plasma protein concentrations.

A

-liver

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16
Q

What plasma protein is the most abundant and is the protein with the most significant losses?

A

-albumin

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17
Q

hypoalbuminemia:

A

-low plasma albumin concentrations.
-albumin helps to maintain fluid balance within the blood;
-thus, low levels contribute to edema by shifting fluid from blood plasma to interstitial spaces

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18
Q

the nephrotic kidney tends to reabsorb ?? in greater amounts than usual, causing sodium and water retention within the body. this can also cause..

A

-sodium
-edema

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19
Q

Individuals with the nephrotic syndrome frequently have elevated levels of which lipoproteins?

A

-low-density lipoproteins (LDL),
-verylow-density lipoproteins (VLDL),
-atherogenic LDL variant known as lipoprotein(a).

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20
Q

deep vein thrombosis:

A

-formation of a stationary blood clot (thrombus) in a deep vein, usually in the leg, which causes inflammation, pain, and swelling, and is potentially fatal.

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21
Q

The nephrotic syndrome is associated with accelerated
?? and a sharply increased risk of heart disease and ??

A

-atherosclerosis
-stroke

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22
Q

The proteins lost in urine include:

A

-immunoglobulins (antibodies) and vitamin D–binding protein.

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23
Q

Depletion of immunoglobulins increases susceptibility to ?? .

A

-infection

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24
Q

Loss of vitamin D–binding protein results in lower vitamin D and ?? levels and increases the risk of ?? in children

A

-calcium
-rickets

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25
Q

If proteinuria continues, ?? and ?? may develop

A

-protein-energy malnutrition (PEM) and
-muscle wasting

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26
Q

Medical treatment of the nephrotic syndrome requires diagnosis and management of
the

A

-underlying disorder responsible for the proteinuria.

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27
Q

Complications of nephrotic syndrome are managed with ?? and ??

A

-medications
-nutrition therapy

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28
Q

The drugs prescribed may include:

A

-diuretics
-ACE inhibitors
-angiotensin receptor blockers (reduce protein losses)
-lipid lowering drugs
-NAIDS (crticosteriods)
-immunosuppressants (cyclosporine)

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29
Q

Nutrition therapy can help to prevent PEM, alleviate ?? , and correct ??
abnormalities.

A

-edema
-lipid

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30
Q

Why are high protein diets not recommended during nephrotic syndrome?

A

-they can increase urinary protein losses and result in further damage to the kidneys

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31
Q

the protein intake should fall between ?? and ?? gram per kilogram of body weight per day

A

-0.8 to 1.0

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32
Q

Dietary measures are usually ?? for controlling blood lipids, however, so physicians may prescribe ?? medications as well.

A

-inadequate
-lipid-lowering

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33
Q

Controlling sodium intake helps to control ?? ; therefore,
the sodium intake may be limited to ?? to ?? milligrams daily

A

-edema
-1000 to 2000

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34
Q

If diuretics prescribed for the edema cause ?? losses, patients are encouraged to select
foods rich in ??

A

-potassium

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35
Q

Multivitamin/mineral supplementation can help patients
avoid nutrient deficiencies; nutrients at risk include ?? and ??

A

-iron
-vitamin D.

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36
Q

acute kidney injury:

A

-the rapid decline of kidney function over a period of hours or days;
-potentially a cause of acute renal failure.

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37
Q

The loss of kidney function reduces ?? output and allows ?? wastes to build up in the blood

A

-urine
-nitrogenous

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38
Q

acute kidney injury is often ?? , although mortality rates are high, ranging from ?? to ?? percent in severe cases.

A

-reversible
-42 to 55%

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39
Q

Most cases of acute kidney injury develop in the ?? , occurring in
about 25 percent of patients undergoing ??

A

-hospital
-intensive care

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40
Q

Many different disorders can lead to acute kidney injury, and it often develops as a
consequence of ???, ??, and ??

A

-critical illness, sepsis, or major surgery.

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41
Q

To aid in diagnosis and treatment of acute kidney disorder, its
causes are classified as

A

-prerenal, intrarenal, or postrenal

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42
Q

Prerenal:

A

-60 to 70% of cases
-conditions that cause a severe reduction in blood flow to the kidneys such as low blood pressure/volume, renal artery disorders or heart disorders

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43
Q

Intrarenal:

A

-25 to 40% of cases
-factors that damage kidney tissue such as renal ischemia, renal injury, and obstructions within the kidney.

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44
Q

Postrenal:

A

-5 to 10% of cases
-factors that prevent urine excretion due to urinary tract obstructions, prostate disorders, renal vein thrombosis, bladder disorders, pregnancy.

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45
Q

A decline in renal function alters the composition of ?? and ?? .

A

-blood and urine

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46
Q

The kidneys become unable to regulate the levels of ?? , ?? , and ?? wastes in the blood

A

-electrolytes
-acid
-nitrogenous

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47
Q

Urine may be diminished in quantity (?? ) or absent (?? ), leading to fluid retention

A

-oliguria
-anuria

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48
Q

Acute kidney injury is often identified when the reduced urinary output is coupled with a
progressive rise in serum ?? levels.

A

-creatinine

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49
Q

Other laboratory findings may include abnormal
levels of serum electrolytes, ??, and various changes in
urine chemistry

A

-elevated blood urea nitrogen (BUN)

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50
Q

why is diagnosis sometimes difficult in acute kidney injury?

A

-clinical effects can be subtle and vary according to the underlying cause of disease

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51
Q

About one-half to two-thirds of patients with acute
kidney injury experience ?? , producing less than about ?? milliliters of urine per
day

A

-oliguria
-400

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52
Q

(normal urine volume is about ?? to ?? milliliters daily

A

-1000 to 1500

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53
Q

The reduced excretion of fluids and electrolytes leads to sodium retention and elevated levels of which minerals in the blood?

A

-potassium, phosphate, and magnesium

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54
Q

hyperkalemia:

A

-elevated serum potassium levels
-of most concern because potassium imbalances can alter heart rhythm and result in heart failure

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55
Q

hyperphosphatemia:

A

-elevated serum phosphate levels
-promote excessive secretion of parathyroid hormone which leads to losses of bone calcium

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56
Q

Due to the sodium retention and reduced urine production, ?? is a common symptom of acute kidney injury and may be apparent as ?? in the face and hands and ?? of the feet and ankles.

A

-edema
-puffiness
-swelling

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57
Q

uremia:`

A

-result of impaired kidney function
-the accumulation of nitrogenous and various other waste products in the blood
-“urine in the blood”

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58
Q

The management of acute kidney injury is primarily supportive; the main goals are to
prevent further:

A

-kidney damage and promote recovery of renal function.

59
Q

treatments of acute kidney injury include:

A

-drug therapies
-dialysis
-dietary modifications to restore F&E balances and minimize blood conc. of toxic wastes

60
Q

In patients with oliguria (reduced urine production), recovery from kidney injury
sometimes begins with a period of ??

A

-diuresis- increased urine production
-large amounts of fluid ( up to 3 liters daily) are excreted

61
Q

Because kidney function is required for drug excretion, patients may need to use lower doses of their usual ?? to compensate for limited urine output

A

-medications

62
Q

. Conversely, ?? treatment may increase losses
of some drugs, and doses may need to be increased

A

-dialysis

63
Q

what kind of drugs must be avoided until kidney function improves? (3)

A

-nephrotoxic drugs (toxic to kidneys)
-antibiotics and nonsteroidal anti-inflammatory drugs

64
Q

Inflammatory conditions may require treatment
with ??

A

-immunosuppressants

65
Q

Edema is treated with diuretics; what is the
usual choice.

A

-furosemide (Lasix)

66
Q

Correction of hyperkalemia may require the use of what medications?

A

-beta-agonists,
-insulin,
-bicarbonate to drive extracellular potassium into cells

67
Q

To reduce serum phosphate levels,
?? may be provided with meals to prevent phosphorus absorption

A

-phosphate binders

68
Q

Acute kidney injury is often associated with other critical illnesses,
so patients may be

A

-hypermetabolic, catabolic, and at high risk of wasting

69
Q

patients with acute kidney injury frequently develop ?? and ?? because they are unable to metabolize energy nutrients efficiently.

A

-hyperglycemia
-hypertriglyceridemia

70
Q

. Protein recommendations are influenced by:

A

-kidney function,
-degree of catabolism,
-the use of dialysis

71
Q

Although guidelines vary, patients are usually provided with ?? to ?? kcalories per
kilogram of body weight per day, while body weight, nitrogen balance, blood glucose
levels, and blood triglycerides are monitored to ensure that the energy intake is appropriate

A

-20 to 30

72
Q

Health practitioners can assess fluid status by monitoring:

A

-weight fluctuations,
-blood pressure,
-pulse rates,
-the appearance of the skin and mucous membranes.

73
Q

Another method is to measure serum sodium concentrations: a low sodium level often
indicates ?? fluid intake, whereas a high sodium level suggests ?? fluid
intake.

A

-excessive
-inadequate

74
Q

daily fluid needs can be estimated by measuring urine output and adding
?? to ?? milliliters to account for the water lost from skin, lungs, and perspiration

A

-400 to 600

75
Q

chronic kidney disease:

A

-gradual, irreversible loss of kidney function because of long-term disease or injury

76
Q

The most common causes of chronic kidney disease are ??
and ??, which are estimated to cause 44 and 28 percent of cases,
respectively

A

-diabetes mellitus
-hypertension

77
Q

Chronic kidney disease affects approximately ?? percent of the U.S.
population.

A

-15%

78
Q

In the early stages of chronic kidney disease, the functional nephrons compensate
for those that are lost or damaged, they do this by:

A

-enlarging and filter blood more rapidly

79
Q

end-stage renal disease:

A

-an advanced stage of chronic kidney disease in which dialysis or a kidney
transplant is necessary to sustain life
-w/o intervention the patient cannot survive

80
Q

glomerular filtration rate (GFR):

A

-how chronic kidney disease is evaluated
-the rate at which filtrate is formed within the kidneys, normally about
125 mL/min in healthy young adults.

81
Q

?? is considered the best index of overall
kidney function, whereas ?? reflects the extent of kidney damage
and correlates well with disease progression and health risks

A

-GFR
-albuminuria

82
Q

As the GFR falls, the increased activity
of the remaining nephrons is often sufficient to maintain ?? excretion;
thus, fluid and electrolyte imbalances may not develop until the ?? or ??
stage of chronic kidney disease.

A

-electrolyte
-fourth or fifth

83
Q

hormonal adaptations that regulate electrolyte levels, but that may cause complications of their own:

A

-aldosterone: increases to help prevent increases in serum potassium but contributes to fluid overload and hypertension
-parathyroid hormone: increases to prevent elevations in serum phosphate but contributes to bone loss and development of renal osteodystrophy(bone disorder)

84
Q

?? may develop during the final stages of chronic kidney
disease, when the GFR falls below about ?? to ?/ milliliters per minute.

A

-Uremia
-10 to 15

85
Q

The metabolic derangements (uremia) that occur in chronic kidney disease
contribute to ?? , why?

A

-protein-energy wasting,
-uremia causes the breakdown of body proteins and negative nitrogen balance

86
Q

A screening method often used for assessing malnutrition in chronic kidney disease is the

A

-Subjective Global Assessment,

87
Q

Drug treatment for chronic kidney disease:

A

-antihypertensive drugs (ACE inhibitors)
-intravenous injection of erythropoietin to treat anemia
-phosphate binders to eat with food to reduce serum phosphate levels
-sodium bicarbonate to reverse acidosis

88
Q

hemodialysis:

A

-a treatment that removes fluids and wastes from the blood by passing the blood through a
dialyzer.

89
Q

dialysate:

A

-the solution used in dialysis to draw fluids and wastes from the blood.

90
Q

peritoneal dialysis:

A

-a treatment that removes fluids and wastes from the blood by using the body’s peritoneal
membrane( membrane surrounding the abdominal cavity) as a filter.

91
Q

As the dietary measures for chronic kidney disease are
complex and nutrient needs change frequently during the course of illness, a ??
who specializes in renal disease is best suited to provide nutrition therapy

A

-dietitian

92
Q

Individuals at risk of protein-energy wasting should
consume foods with ??

A

-high energy density: high number of kcalories per unit of food

93
Q

Most dialysates used in peritoneal dialysis contain ?? in order to draw fluid
from the blood to the peritoneal cavity by ?? ; on average, about 64 percent of this
glucose is absorbed

A

-glucose
-osmosis

94
Q

kcalories from glucose: must be included in estimates of energy intake

A

-600

95
Q

what can be a problem when peritoneal dialysis continues for a long period of time?

A

-weight gain

96
Q

?? proteins should be included in the diet as they place less demand on the kidneys than animal proteins and may also reduce urinary phosphate levels and acid production

A

-Plant-based

97
Q

Once dialysis has begun, protein restrictions
can be ?? because dialysis removes nitrogenous wastes and results in some amino
acid losses as well.

A

-relaxed

98
Q

Patients with chronic kidney disease are told to consume high fat foods to improve their energy intakes, these foods should provide mostly what kind of fat?

A

-unsaturated

99
Q

Once a person is on dialysis, sodium and fluid intakes should be controlled
so that only about ?? pounds of water weight are gained daily—this excess fluid is then
removed during the next dialysis treatment

A

-2

100
Q

Patients on fluid-restricted diets should be
advised that foods such as ??
contribute to the fluid allowance.

A

-flavored gelatin, soup, fruit ices, and frozen fruit juice bars

101
Q

Most patients can handle typical intakes of potassium during stages
?? through ?? of illness

A

-1 through 4

102
Q

. Restriction is necessary for individuals treated with
/??, whereas those undergoing peritoneal dialysis can consume potassium
more freely

A

-hemodialysis

103
Q

Patients with chronic kidney disease are typically encouraged to increase their ?? and
?? intakes because these foods can help to reduce acid production in the body

A

-fruit and vegetable

104
Q

To minimize the risk of bone disease,
serum ?? and ?? levels are monitored in patients with renal disease,
and laboratory values help to guide recommendations

A

-phosphate and calcium

105
Q

Elevated serum phosphate
levels indicate the need for dietary ?? restriction and, if necessary, the
use of ??

A

-phosphorus
-phosphate binders (taken with meals)

106
Q

Many phosphate binders are ?? , and patients using these binders may be at risk of developing ?>? in response to simultaneous calcium and vitamin D supplementation.

A

-calcium salts
-hypercalcemia

107
Q

. Routine supplementation with
vitamins ? and ? is not recommended due to the risk of toxicity

A

-A AND E

108
Q

what mineral deficiency is common in patients undergoing hemodyalysis?

A

-iron
-intravenous administration of iron is more effective that oral

109
Q

intradialytic parenteral nutrition:
What does it contain?

A

-the infusion of nutrients during hemodialysis,
-providing amino acids, dextrose, lipids, and some trace minerals

110
Q

A preferred alternative to dialysis in patients with end-stage renal disease is ??

A

-kidney transplantation.

111
Q

To prevent tissue rejection following transplant
surgery, patients require high doses of immunosuppressive drugs such as

A

-corticosteroids, cyclosporine, tacrolimus, and mycophenolic acid

112
Q

Because immunosuppressive drug therapy increases the
risk of ?? infection, food safety guidelines should be provided to patients and
caregivers

A

-foodborne

113
Q

If corticosteroids are used as immunosuppressants after kidney transplantation, ?? supplementation is recommended because the medication increases
urinary calcium losses.

A

-calcium

114
Q

Approximately ?? percent of men and ? percent of women in the United States develop
one or more kidney stones during their lifetimes

A

-11
-7

115
Q

kidney stones:

A

-crystalline masses that form in the urinary tract

116
Q

Most common type of kidnney stone is:
kidney stones can be as small as ?? or as large as a ??

A

-calcium oxalate
-bread crumb
-golf ball

117
Q

Less commonly, stones are composed of

A
  • calcium phosphate,
    -uric acid,
    -amino acid cystine,
    -magnesium ammonium phosphate
118
Q

Factors that predispose an individual to stone formation include the
following:

A

-dehydration or low urine volume
-changes in urine acidity: either acidic or alkaline
-metabolic abnormalities
-obstruction

119
Q

The most common metabolic abnormality in people with calcium
oxalate stones is ??

A

-hypercalciuria, elevated urinary calcium levels

120
Q

hyperoxaluria:

A

-elevated urinary oxalate levels that can result in kidney stones

121
Q

what is a normal product of metabolism that readily binds to calcium?

A

-oxalate

122
Q

What can also increase oxalate absorption? and how?

A

-fat malabsorption
-malabsorbed fatty acids bind to minerals (calcium & magnesium) that would otherwise bind to oxalates and inhibit their absorption.

123
Q

how does hypocitraturia contribute to forming calcium stones?

A

-citrates in urine combine with calcium and inhibit calcium’s tendency to bind to oxalates and other compounds.

124
Q

uric acid stones:

A

-develop when the urine is abnormally acidic

125
Q

who normally develops uric acid stones?

A

-individuals with gout

126
Q

what kind of diet contributes to high uric acid levels?

A

-diet rich in purines: abundant in animal proteins (meat, poultry, and seafood.

127
Q

Cystine stones can form in people
with the inherited disorder ??

A

-cystinuria, in which renal tubules are unable to reabsorb the amino acid cystine.

128
Q

Struvite stones, composed primarily of ?? phosphate, form
in ??urine

A

-magnesium ammonium
-alkaline

129
Q

why is the urines pH sometimes raised?

A

-bacteria in urine degrade urea to ammonia

130
Q

Struvite stones can accompany ?? or
disorders that interfere with urinary flow.

A

-chronic urinary infections

131
Q

renal colic:

A

-the intense pain that occurs when a kidney stone passes through the ureter; the
pain typically begins in the back and intensifies as the stone travels
toward the bladder.

132
Q

hematuria:

A

-blood in the urine.

133
Q

Depending on the location of the stone, symptoms may
include:

A

-urination urgency and frequency
-inability to urinate

134
Q

Solutes are less likely to crystallize and form stones in ?? urine.

A

-dilute

135
Q

people who form kidney stones are advised to drink ?? or more cups of fluid daily to maintain a
urine volume of at least 2 to 2½ liters per day

A

12

136
Q

Patients should
consume ?? calcium from food sources (about 800 to 1200 milligrams per day)
because dietary calcium combines with oxalate in the intestines, reducing oxalate
absorption and helping to control hyperoxaluria

A

-adequate

137
Q
  • Conversely, ?? -calcium diets promote
    oxalate absorption and higher urinary oxalate levels
A

-low

138
Q

Vitamin C supplements should be ?? because vitamin C degrades
to oxalate; thus, increased intakes can raise urinary oxalate levels

A

-avoided

139
Q

Medications used to prevent calcium oxalate stones include:

A

-thiazide diuretics, which reduce urinary calcium excretion;
-potassium citrate, which increases urinary citrate levels;
-allopurinol (Zyloprim), which reduces uric acid production in the body

140
Q

Drug treatments for uric acid stones include:

A

-allopurinol to reduce serum uric acid levels
-potassium citrate to reduce urine acidity.

141
Q

Medications to treat cystine and struvite stones:

A

-PENICILLAMIN (CUPRIMINE)
-TIOPRONIN (THIOLA)

142
Q

Medications that relax the ureter and increase urine volume may be given to facilitate
stone passage; examples include:

A

-alpha-receptor blockers and calcium channel blockers

143
Q

extracorporeal shockwave lithotripsy

A

-procedure that uses high amplitude sound waves to degrade the stone

clinical nutrition (26 decks)

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