Medical Nutrition Therapy - D. Renal (p. 12-15) Flashcards
The functional unit of the renal system. All blood passes through this to be cleansed.
Nephron
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).
Glomerulus
The _______ ______ produces ultrafiltrate, which passes through the tubules. It blocks the passage of RBCs and protein, which are not filtered and remain in circulation.
Bowman’s capsule
Major nutrient REABSORPTION takes place here.
Connects the glomerulus with the loop of Henle.
PROXIMAL TUBULE
Water and sodium balance is regulated here.
Loop of Henle
Acid-base balance is regulated here.
DISTAL TUBULE
Renal functions include: 1. 2. 3. 4.
- FILTRATION (RBC and PTN stay in blood, ALL ELSE filters through)
- ABSORPTION (absorbs most water and electrolytes)
- EXCRETION (waste, urea, ketones)
- SECRETION (secretes hormones that control blood pressure, and ions that maintain acid-base balance)
Hormone involved in renal function. Antidiuretic hormone (increases water reabsorption) INCREASES blood pressure.
Stored in pituitary gland, secreted by hypothalamus.
Vasopressin (ADH)
Hormone involved in renal function.
Vasoconstrictor.
INCREASES blood pressure.
Produced in kidney, secreted by glomerulus.
Renin
Hormone involved in renal function.
Stimulates bone marrow to produce RBCs.
INCREASES RBCs.
Produced by kidney.
Erythropoietin (EPO)
In renal disease,
GFR is _______.
Creatinine clearance is ______.
Serum creatinine is _______.
BUN is _________.
GFR and Creatinine Clearance is DECREASED. (urine tests)
Serum Creatinine and BUN is INCREASED. (blood tests)
BUN:CREAT ratio >20:1 indicates:
“____-____ state”, in which BUN reabsorption is _______.
This is [reversible/irreversible] and [does/does not] not require dialysis.
BUN:CREAT ratio >20:1 indicates:
“Pre-renal state”, in which BUN reabsorption is INCREASED.
This is reversible and does not not require dialysis.
BUN:CREAT ratio
BUN:CREAT ratio
Renal solute load mainly measures _______ and _______.
Renal solute load mainly measures NITROGEN and SODIUM.
Manifestations of renal disease include:
_______ (due to decreased production of erythropoietin)
Altered _____ _______
Decreased activation of vitamin __ (kidney produces active form, which promotes Ca absorption)
Anemia
Altered blood pressure
Decreased activation of vitamin D
Renal calculi is another word for _______ ______.
Kidney stones
The most common kidney stone is the _______.
The most common kidney stone is the calcium stone (calcium oxalate stone).
Diet therapy for calcium oxalate stones is ______ calcium and ______ oxalate (dark leafy greens, chocolate, tea).
Adequate calcium (binds oxalate) Low oxalate
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.
Ash, Ash
Diet
To prevent ACIDIC stones, create an ________ ash by increasing intake of fruits and vegetables.
ALKALINE
To prevent ALKALINE stones, create an _______ ash bu increasing intake of meat, fish, eggs, and cheese.
ACIDIC
The sudden shutdown of the kidney associated with trauma.
Acute Kidney Injury (acute renal failure)
Symptoms of AKI include _________, or urine output
Oliguria:
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).
Protein
Phosphorous, potassium
Protein Needs in AKI
__-__ g/kg - noncatabolic, without dialysis as GFR returns to normal
__-__ g/kg - catabolic, and/or dialysis
- 0-1.3 g/kg - noncatabolic, no dialysis
1. 2-1.5 g/kg - catabolic, dialysis
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.
Nephrotic syndrome
Symptoms of nephrotic syndrome include:
*_________
*_________
Edema
Malnutrition
Symptoms of nephrotic syndrome include:
*Albuminuria
*Hyperlipidemia
Edema
Malnutrition
Diet therapy for nephrotic syndrome:
- Modest _______
- Restrict _______
Modest PROTEIN (0.8-1.0 g/kg) - Excess will be catabolized and excreted
Restrict FAT (hyperlipidemia - INC synthesis and DEC clearance)
Gradual loss of kidney function over time.
Chronic kidney disease
Anemia associated with CKD due to deficient production of hormone _______ by kidney.
Erythropoietin (EPO)
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
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
*Protein is restricted in stage ___ (GFR 30-59) and stage __ (GFR 15-29).
Restricted to 0.6-0.8 g/kg.
Stage 3 (GFR 30-59) and Stage 4 (GFR 15-29)
In stages 1 and 2, maintain normal serum level of ______. In stages 3 and 4, restrict to 800-1000 mg/d.
Phosphorous
_______ is generally not restricted unless serum is elevated.
Potassium
Few functioning nephrons remain. Associated with a BUN >100 mg/dL and Creat 10-12 mg/dL (10:1 BUN:Creat ratio).
End stage renal disease (ESRD)
In CKD, ________ is retained, requiring a very low protein intake. HBV protein best. Goals are to control ___ and prevent deficiencies.
Nitrogen
In CKD, the diet is liberalized with the initiation of _______.
Dialysis
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
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
