Chapter 29: MNT in Renal Disorders Flashcards
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
kidneys
the functioning unit of the kidney is called
nephron
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
kidneys
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
-
to estimate GFR
CKD-EPI Creatinine Equation
a disorder characterized by an abrupt cessation or decline in GFR that results in failure to maintain fluid, electrolyte, and acid-base balance
acute kidney injury
AKI - etiology
conditions that reduce perfusion and cause ishemic damage to the kidney
pre-renal AKI
AKI - etiology
causes: severe dehydration, circulatory collapse, or fluid losses from the GI tract or from extensive wounds, such as occurs with burns
pre-renal AKI
AKI - etiology
damage within the kidney cells
intrinsic or parenchymal AKI
AKI - etiology
causes: exposure to toxins (antibiotics, chemotherapy, or contrast dyes used in various imaging tests) or with systemic inflammatory conditions like sepsis
intrinsic or parenchymal AKI
AKI - etiology
blockage of the ureter or neck of the bladder
post-renal or obstructive AKI
AKI - etiology
causes: kidney stones, blood clots, and tumors
post-renal or obstructive AKI
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
chronic kidney disease
chronic kidney disease: GFR values
<60 ml/min/1.32 m2 for 3 months or longer
chronic kidney disease: albuminuria values
more than 30 mg of urinary albumin per g
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
dialysis
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
hemodialysis (HD)
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
hemodialysis (HD)
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
peritoneal dialysis (PD)
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
peritoneal dialysate (PD)
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
continuous ambulatory peritoneal dialysis (CAPD)
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
continuous cycling peritoneal dialysis
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
renal transplantation
also known as kidney stones
nephrolithiasis
forms as a result of abnormal crystallization of calcium, oxalate, struvite, cysteine, hydroxyapatite, or uric acid not excreted normally in the urine
nephrolithiasis
risk factors:
-family history
-previous stone formation
-certain medical conditions (hypercalciuria, hyperuricosuria, and hyperoxaluria)
-low urine volume
-malabsorption
nephrolithiasis
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
extracorporeal shock wave lithotripsy (ESWL)
nephrolithiasis - medical treatment
used when the stone is located in the mid- and lower- ureter area
ureterorenoscopy URS)
