Chapter 29: MNT in Renal Disorders

Question 1

2 bean-shaped organs, each about the size of a fist

made up of a complex capillary network and an array of tubules that perform regulatory and metabolic functions that are vital to life

Answer 1

kidneys

Question 2

the functioning unit of the kidney is called

Answer 2

nephron

Question 3

kidneys - primary function:

-maintenance of homeostasis thru control of fluid, pH, and electrolyte balance and blood pressure
-excretion of metabolic end products and foreign substances
-production of enzymes and hormones

Answer 3

kidneys

Question 4

the National Kidney Foundation (NKF) KDOQI (Kidney Disease Outcomes Quality Initiative) Guideline recommends using equation based on serum creatinine (adj. for ethnicity, age, sex) and specifically the CKD-EPI creatinine equitation to estimate GFR

Answer 4

-

Question 5

to estimate GFR

Answer 5

CKD-EPI Creatinine Equation

Question 6

a disorder characterized by an abrupt cessation or decline in GFR that results in failure to maintain fluid, electrolyte, and acid-base balance

Answer 6

acute kidney injury

Question 7

AKI - etiology

conditions that reduce perfusion and cause ishemic damage to the kidney

Answer 7

pre-renal AKI

Question 8

AKI - etiology

causes: severe dehydration, circulatory collapse, or fluid losses from the GI tract or from extensive wounds, such as occurs with burns

Answer 8

pre-renal AKI

Question 9

AKI - etiology

damage within the kidney cells

Answer 9

intrinsic or parenchymal AKI

Question 10

AKI - etiology

causes: exposure to toxins (antibiotics, chemotherapy, or contrast dyes used in various imaging tests) or with systemic inflammatory conditions like sepsis

Answer 10

intrinsic or parenchymal AKI

Question 11

AKI - etiology

blockage of the ureter or neck of the bladder

Answer 11

post-renal or obstructive AKI

Question 12

AKI - etiology

causes: kidney stones, blood clots, and tumors

Answer 12

post-renal or obstructive AKI

Question 13

having a GFR of less than 60 ml/min/1.73m2 for 3 months or longer and/or albuminuria of more than 30 mg of urinary albumin per gram of urinary creatinine

Answer 13

chronic kidney disease

Question 14

chronic kidney disease: GFR values

Answer 14

<60 ml/min/1.32 m2 for 3 months or longer

Question 15

chronic kidney disease: albuminuria values

Answer 15

more than 30 mg of urinary albumin per g

Question 16

CKD - treatment

a renal replacement procedure that removes excessive and toxic by-products of metabolism from the blood, thus replacing the filtering function of healthy kidneys

Answer 16

dialysis

Question 17

CKD - treatment (types of dialysis for CKD stage 5)

is the removal of fluid and wastes from the blood by passing thru an artificial kidney (dialyzer)

requires permanent access to the bloodstream thru a fistula created by surgery to connect an artery and vein

Answer 17

hemodialysis (HD)

Question 18

CKD - treatment (types of dialysis for CKD stage 5)

large needles are inserted into the fistula before each dialysis and removed when dialysis is complete

waste products and electrolytes move by diffusion, ultrafiltration, and osmosis from the blood into the dialysate and are removed

Answer 18

hemodialysis (HD)

Question 19

CKD - treatment (types of dialysis for CKD stage 5)

the removal of wastes and fluid from the body using the peritoneum in the abdomen

a catheter is surgically implanted thru the abdomen and into the peritoneal cavity

Answer 19

peritoneal dialysis (PD)

Question 20

CKD - treatment (types of dialysis for CKD stage 5)

dialysate containing a high-dextrose concentration is instilled into the peritoneum. where diffusion carries waste products from the blood through the peritoneal membrane and into the dialysate; water moves by osmosis

fluid is then withdrawn and discarded, and new solution is added multiple times each day

Answer 20

peritoneal dialysate (PD)

Question 21

2 main types of PD

requires no machine; usual dwell time is 4-6 hrs, followed by draining of used dialysate and its replacement with fresh solution which required additional 30-40 mins

Answer 21

continuous ambulatory peritoneal dialysis (CAPD)

Question 22

2 main types of PD

requires a cycler to fill and empty the abdomen 3-5x during the night

1 exchange is done at day time and lasts the entire day

some patients require an additional exchange in the afternoon

Answer 22

continuous cycling peritoneal dialysis

Question 23

a surgical procedure where a healthy kidney form a living or deceased donor is placed into a person whose kidneys no longer function properly

after procedure, patients are maintained on a variety of immunosuppressive regimens to prevent rejection of the donated kidney

Answer 23

renal transplantation

Question 24

also known as kidney stones

Answer 24

nephrolithiasis

Question 25

forms as a result of abnormal crystallization of calcium, oxalate, struvite, cysteine, hydroxyapatite, or uric acid not excreted normally in the urine

Answer 25

nephrolithiasis

Question 26

risk factors:

-family history
-previous stone formation
-certain medical conditions (hypercalciuria, hyperuricosuria, and hyperoxaluria)
-low urine volume
-malabsorption

Answer 26

nephrolithiasis

Question 27

nephrolithiasis - medical treatment

(ESWL) - medical procedure using shockwaves to destroy or break up stones which are then passed thru the urinary tract in the urine

Answer 27

extracorporeal shock wave lithotripsy (ESWL)

Question 28

nephrolithiasis - medical treatment

used when the stone is located in the mid- and lower- ureter area

Answer 28

ureterorenoscopy URS)