Kidney Disease

Question 1

Basic functions of kidney

Answer 1

1) waste removal
2) acid/base balance (bicarbonate/phos/pH 7.4ish)
3) endocrine (vit D/EPO)
4) fluid and electrolyte balance

Question 2

Causes of AKI

Answer 2

1) pre renal - restriction of blood going into kidney (eg, dehydration, blockage, surgical blood loss, heart or liver failure) - 60-70% of cases
2) post renal urinary tract obstruction - “obstructive renal failure” blocking kidney output (eg, kidney stone, cancer, prostate, bladder cancer) - 5-10%
3) intrinsic disease of kidney - damage to kidney itself (eg, trauma, surgery, septicemia) - 25-40% - most complicated

Question 3

MNT for AKI

Answer 3

Protein - high 1.4-2.0 nondialysis; 1-2 dialysis; up to 2.5 for CRRT

Energy - 30-40 kcal

K and Na - slightly restricted

Question 4

Blood consequences of failing kidneys

Answer 4

Serum creatinine - high b/c not being eliminated - normal is 0.5 - 1.5 and ESRD is 10-12.

Uric acid - high - is product of purine catabolism

BUN - high - kidneys can’t excrete urea - leads to uremic symptoms

Hgb and Hct - low - because kidneys not making EPO

Question 5

GFR

Answer 5

Glomerular filtration rate - best index of kidney function - amount of filtrate formed per min based on surface area (number of working glomeruli)

• decreases as kidney function decreases
• used to establish stage of CKD
• can be calculated from serum creatinine

Question 6

Normal GFR

Answer 6

130 ml/min

Question 7

Stage 5 GFR

Answer 7

15-0 ml/min

Question 8

Uremic syndrome

Answer 8

Fatigue, weakness
Diminished mental alertness
Muscle twitches, cramps
Anorexia, N/V, stomatitis
Unpleasant taste in mouth
Itchy skin
Uremic frost

Question 9

Most common kidney diseases in order

Answer 9

Diabetic nephropathy
High blood pressure
Polycystic kidney disease - hereditary
AKI
CKD
ESRD

Question 10

MNT for CKD

Answer 10

Before dialysis - restrict protein

• 0.8 with 60% HBV for GFR > 55
• 0.6 with 50% HBV for GFR 25-55
• kcal 35 and can increase protein to 0.75 if inadequate kcal

After dialysis pro is 1.2-1.5

Control hypertension

Question 11

MNT predialysis

Answer 11

Protein 0.8 if GFR > 55; 0.6 if 25-55; 60% HBV

energy: 35-40
Na: 1000-3000 if nec
P: 8-12
K:unrestricted
Ca: 1200-1600
Fluid: ad lib

Question 12

MNT for HD

Answer 12

Protein: 1.1-1.4
Energy: 30-35
Na: 2000-3000
K: 40 mg/kg
P:

Question 13

MNT for PD

Answer 13

Protein: 1.2-1.5
Energy: 25-35
Na: 2000-4000
K: unrestricted
P: