Medical Nutrition Therapy - D. Renal (p. 12-15)

Question 1

The functional unit of the renal system. All blood passes through this to be cleansed.

Answer 1

Nephron

Question 2

The nephron includes the _______, tufts of capillaries held together by the Bowman’s capsule (Bowman’s capsule contains the glomerulus - like a wand with a crystal ball on the end lol).

Answer 2

Glomerulus

Question 3

The _______ ______ produces ultrafiltrate, which passes through the tubules. It blocks the passage of RBCs and protein, which are not filtered and remain in circulation.

Answer 3

Bowman’s capsule

Question 4

Major nutrient REABSORPTION takes place here.

Connects the glomerulus with the loop of Henle.

Answer 4

PROXIMAL TUBULE

Question 5

Water and sodium balance is regulated here.

Answer 5

Loop of Henle

Question 6

Acid-base balance is regulated here.

Answer 6

DISTAL TUBULE

Question 7

Renal functions include:
1.
2.
3.
4.

Answer 7

1. FILTRATION (RBC and PTN stay in blood, ALL ELSE filters through)
2. ABSORPTION (absorbs most water and electrolytes)
3. EXCRETION (waste, urea, ketones)
4. SECRETION (secretes hormones that control blood pressure, and ions that maintain acid-base balance)

Question 8

Hormone involved in renal function.
Antidiuretic hormone (increases water reabsorption)
INCREASES blood pressure.

Stored in pituitary gland, secreted by hypothalamus.

Answer 8

Vasopressin (ADH)

Question 9

Hormone involved in renal function.
Vasoconstrictor.
INCREASES blood pressure.

Produced in kidney, secreted by glomerulus.

Answer 9

Renin

Question 10

Hormone involved in renal function.
Stimulates bone marrow to produce RBCs.
INCREASES RBCs.

Produced by kidney.

Answer 10

Erythropoietin (EPO)

Question 11

In renal disease,

GFR is _______.
Creatinine clearance is ______.

Serum creatinine is _______.
BUN is _________.

Answer 11

GFR and Creatinine Clearance is DECREASED. (urine tests)

Serum Creatinine and BUN is INCREASED. (blood tests)

Question 12

BUN:CREAT ratio >20:1 indicates:

“____-____ state”, in which BUN reabsorption is _______.
This is [reversible/irreversible] and [does/does not] not require dialysis.

Answer 12

BUN:CREAT ratio >20:1 indicates:

“Pre-renal state”, in which BUN reabsorption is INCREASED.
This is reversible and does not not require dialysis.

Question 13

BUN:CREAT ratio

Answer 13

BUN:CREAT ratio

Question 14

Renal solute load mainly measures _______ and _______.

Answer 14

Renal solute load mainly measures NITROGEN and SODIUM.

Question 15

Manifestations of renal disease include:

_______ (due to decreased production of erythropoietin)
Altered _____ _______
Decreased activation of vitamin __ (kidney produces active form, which promotes Ca absorption)

Answer 15

Anemia
Altered blood pressure
Decreased activation of vitamin D

Question 16

Renal calculi is another word for _______ ______.

Answer 16

Kidney stones

Question 17

The most common kidney stone is the _______.

Answer 17

The most common kidney stone is the calcium stone (calcium oxalate stone).

Question 18

Diet therapy for calcium oxalate stones is ______ calcium and ______ oxalate (dark leafy greens, chocolate, tea).

Answer 18

Adequate calcium (binds oxalate)
Low oxalate

Question 19

Minerals not oxidized in metabolism leave a residue (___) in the urine. The pH of ___ in urine can be changed with _____, and be used to prevent kidney stones.

Answer 19

Ash, Ash

Diet

Question 20

To prevent ACIDIC stones, create an ________ ash by increasing intake of fruits and vegetables.

Answer 20

ALKALINE

Question 21

To prevent ALKALINE stones, create an _______ ash bu increasing intake of meat, fish, eggs, and cheese.

Answer 21

ACIDIC

Question 22

The sudden shutdown of the kidney associated with trauma.

Answer 22

Acute Kidney Injury (acute renal failure)

Question 23

Symptoms of AKI include _________, or urine output

Answer 23

Oliguria:

Question 24

Diet therapy for AKI involves an initial _______ restriction, followed by advances with improved renal function.

Low _______ (may need phosphate binders) and low _______ (watch to prevent hyperkalemia).

Answer 24

Protein

Phosphorous, potassium

Question 25

Protein Needs in AKI

__-__ g/kg - noncatabolic, without dialysis as GFR returns to normal

__-__ g/kg - catabolic, and/or dialysis

Answer 25

1. 0-1.3 g/kg - noncatabolic, no dialysis

1. 2-1.5 g/kg - catabolic, dialysis

Question 26

Disorder that causes excess protein excretion in urine.

Caused by damage to/defect of glomerulus - permits large amount of protein to scape into filtrate and move through tubules.

Answer 26

Nephrotic syndrome

Question 27

Symptoms of nephrotic syndrome include:

*_________
*_________
Edema
Malnutrition

Answer 27

Symptoms of nephrotic syndrome include:

*Albuminuria
*Hyperlipidemia
Edema
Malnutrition

Question 28

Diet therapy for nephrotic syndrome:

• Modest _______
• Restrict _______

Answer 28

Modest PROTEIN (0.8-1.0 g/kg) - Excess will be catabolized and excreted

Restrict FAT (hyperlipidemia - INC synthesis and DEC clearance)

Question 29

Gradual loss of kidney function over time.

Answer 29

Chronic kidney disease

Question 30

Anemia associated with CKD due to deficient production of hormone _______ by kidney.

Answer 30

Erythropoietin (EPO)

Question 31

Protein in CKD:

Stage 1 (GFR >90) and Stage 2 (GFR 60-89): __-__ g/kg

Stage 3 (GFR 30-59) and Stage 4 (GFR 15-29): __-__ g/kg

Answer 31

Protein in CKD:

Stage 1 (GFR >90) and Stage 2 (GFR 60-89): 0.8-1.4 g/kg

Stage 3 (GFR 30-59) and Stage 4 (GFR 15-29): 0.6-0.8 g/kg

Question 32

*Protein is restricted in stage ___ (GFR 30-59) and stage __ (GFR 15-29).

Restricted to 0.6-0.8 g/kg.

Answer 32

Stage 3 (GFR 30-59) and Stage 4 (GFR 15-29)

Question 33

In stages 1 and 2, maintain normal serum level of ______. In stages 3 and 4, restrict to 800-1000 mg/d.

Answer 33

Phosphorous

Question 34

_______ is generally not restricted unless serum is elevated.

Answer 34

Potassium

Question 35

Few functioning nephrons remain. Associated with a BUN >100 mg/dL and Creat 10-12 mg/dL (10:1 BUN:Creat ratio).

Answer 35

End stage renal disease (ESRD)

Question 36

In CKD, ________ is retained, requiring a very low protein intake. HBV protein best. Goals are to control ___ and prevent deficiencies.

Answer 36

Nitrogen

Question 37

In CKD, the diet is liberalized with the initiation of _______.

Answer 37

Dialysis

Question 38

HEMODIALYSIS

1.2 g/kg protein, at least 50% HBW
35 kcal/kg (60 y/o or obese)

Fluid restriction if retaining fluid
2-3 g potassium
800-1000 mg phosphorous

Answer 38

PERITONEAL DIALYSIS

1.2-1.3 g/kg protein, >50% HBW
35 kcal/kg (60 y/o or obese) (including dialysate)

Potassium generally unrestricted (2-4 g)
800-1000 mg phosphorous