Kidney and diet and stuffs Flashcards
AKI characteristics (acronym)
WADE
Waste product buildup
Abnormal volume status
Decreased eGFR
Electrolyte imbalance
accelerated protein breakdown
AKI
must increase protein intake!
must increase protein intake
AKI
eGFR <60
Chronic kidney disease if this persists for 3+ months
eGFR is 98, what stage
stage 1 = >90
eGFR is 62, what stage
stage 2 = 60-90
eGFR is 54, what stage
stage 3a = 45-59
eGFR is 43, what stage
stage 3b = 30-44
eGFR is 28, what stage
stage 4 = 16-29
eGFR is 12, what stage
stage 5 = <15
CKD affects which metabolic pathway (acronym)
P - FEN
Protein homeostasis and metabolism (may need protein restriction)
Feedback mechanisms (thirst, taste and appetite)
Energy homeostasis (especially in dialysis pts, may develop cachexia)
Nutrient metabolism (Ca, Iron, B,C,D vitamins, zinc, selenium, manganese and may cause aluminum toxicity.)
What are possible “treatments” for AKI
- fluid replacement if hypovolemic
- electrolytes will fix themselves
- increase protein intake if AKI lasts longer than a few days (1.5-2.5 g/kg/day where normal is .8g/kg/day)
what are the structural or functional markers of kidney damage on:
Imaging
labs
imaging - polycystic kidneys, increased echogenicity, atrophy
labs - hematuria, proteinuria, abnormal “cast shedding” wtf is that idk
what are the feedback mechanisms that are altered in CKD
thirst, appetite, taste
what patients are more at risk for alteredenergy homeostasis in CKD? what might they develop?
hemodialysis patients
may develop cachexia
what nutrient metabolism is altered in CKD
Ca absrob decrease
Iron absorption decreased
B, C, D(active form) vitamin def
zinc, selenium, manganese def
at risk for aluminum toxicity
describe the difference in protein intake in CKD vs AKI
CKD wants protein restriction to slow down deterioration of kidney function
AKI wants increased injury because there is increased protein metabolism
what CKD patient actually needs increased protein? what are the two different types
dialysis patients
hemodialysis = 1-1.2 g/kg/day
peritoneal dialysis = 1.3g/kg/day
hyperkalemia is seen when in this lecture
with PLADO diet for CKD
also in late stage CKD cuz patients cant excrete potassium
in this diet you supplement AA, ketoacids and hydroxy acids and keep protein intake below .43 g/kg/day
very low protein diet w supplementation
what food provides too much phosphate and potential acid load for CKD patients
animal proteins
promotes nitrogen excretion and lowers inflammation
fiber
this is associated with better mortality rates in CKD patients
high fiber intake
high fat consumption can increase….
glomuler pressure
albuminuria
what can you do to your foods to decrease potassium intake
boiling fruits and vegetables
what foods have the highest PRAL
“potential renal acid load”
hard cheese and egg yolks
(animal based foods in general)
what foods have the lowest PRAL
raisins and spinach
(plant based in general)
how can we decrease a patients acid levels in CKD
have them eat 2-4 cups of fruits/veggies daily
supplement w sodium bicarbonate
compare the absoprtion of organic v inorganic phosphorus
organic - natural in foods 30-60% absorb
inorganic - dark sodas, processed foods (preservative) - >90% absorbed
how does CKD affect vitamin D in the body
(you literally know this, we talked about Vitamin D in the last endo exam with hyperparathyroidism just use your brain)
CKD = decreased converison of Vit D to active Vit D
this leads to decreased ca+ absoprtion in GI (hypyocalcemia!)
corrected w vitamin D replacement
what supplementation may help with lipid levels in CKD
carnitine
what minerals are decreased in CKD but are not recommended to supplement since the health outcome is not changed.
zinc/selenium
how long does eGFR have to be under 60 for CKD to be diagnosed
3+ months
what mineral is at risk for causing toxicity in CKD patients
aluminum
what patients are more at risk for alteredenergy homeostasis in CKD? what might they develop?
hemodialysis patients
may develop cachexia
what diet decreases protein intake to .6-.8 g/kg/day
plant-dominant low protein diet (PLADO)
what stage is protein restriction started in CKD
stage 3-5 (.6-.8 g/kg/day PLADO)
