Kidney Disease

Question 1

functions of the kidney

Answer 1

regulates extracellular fluid volume and osmolarity, electrolyte concentrations, and acid-base balance
excretes metabolic waste products
secretes renin (helps to regulate BP)
produces erythropoietin (stimulates RBC production)
converts vitamin D to its active form

Question 2

chronic kidney disease facts

Answer 2

the overall prevalence of CKD in the general population is approximately 14 percent
high blood pressure and diabetes are the main causes of CKD
- almost half of individuals with CKD also have diabetes and/or self-reported cardiovascular disease (CVD)
compared to Caucasians, ESRD prevalence is about 3.7 times greater in African Americans, 1.4 times greater in Native Americans, and 1.5 times greater in Asian Americans
each year, kidney disease kills more people than breast or prostate cancer
- in 2013, more than 47,000 Americans died from kidney disease

Question 3

chronic kidney disease

Answer 3

gradual and irreversible deterioration
- usually not diagnosed until most of the kidney function has been lost
causes:
- diabetes mellitus (44%)
- hypertension (28%)
- inflammatory, immunological, or hereditary diseases

Question 4

consequences of CKD

Answer 4

nephrons enlarge to compensate
overburdened nephrons degenerate
end-stage renal disease (ESRD) can occur
fluid/electrolyte imbalances may not occur until the 3rd or 4th stage of CKD

Question 5

treatment for CKD

Answer 5

medications:
- antihypertensive drugs to treat disease progression and protect the heart( ACE inhibitors)
- phosphate binders to reduce phosphate levels
- statins
dialysis

Question 6

hemodialysis

Answer 6

dialysis replaces kidney function by removing excess fluid and wastes from the blood

Question 7

nutritional considerations for CKD

Answer 7

choose and prepare foods with less sodium
eat the right amount and the right types of protein
- high-quality proteins from both plant and animal sources
choose foods that are heart healthy
limit or eliminate alcohol
choose foods and drinks with less phosphorus
- barely, bran, fish, milk, nuts, tofu
- look for “PHOS” on the food labels
choose foods with the right amount of potassium
- fruits and veggies

Question 8

caring for patients with CKD

Answer 8

partner with registered dietician
- nutrients needs are complex and can change frequently
- individual patients may need more or less of nutrients
remember to think holistically (beyond the kidneys)
- what other co-morbidities does the patient have
- cultural and religious considerations
- mental health

Question 9

kidney stone formation

Answer 9

dehydration or low urine volume
changes in urine acidity (affects the dissolution of urinary constituents)
metabolic abnormalities
obstruction of the urinary tract

Question 10

calcium oxalate stone

Answer 10

most common type of kidney stone
often caused by:
- hypercalciuria (elevated urinary calcium levels) - excessive calcium absorption, impaired calcium reabsorption in kidney tubules, or elevated parathyroid hormone or vitamin D
- hyperoxaluria (increase in body’s synthesis of oxalate) - increased absorption of oxalate from dietary sources or fat malabsorption

Question 11

nutritional intervention for kidney stones

Answer 11

drinking enough liquid, mainly water, is the most important thing to prevent kidney stones
- unless the patient has kidney failure, drink six to eight, 8-ounce glasses a day
consume enough dietary calcium to control oxalate absorption
restrict dietary oxalate
moderate protein intake
sodium restriction
avoid vitamin C supplements (degrades to oxalate)