MNT for Renal Disease Part 1 Flashcards
The ___ ___ brings oxygenated blood to the kidneys
Renal artery
The ___ ___ takes deoxygenated blood from the kidneys back to the heart
Renal vein
____ are the functional unit of the kidney and act as the “filter”
Nephrons
There are ____ million nephrons per kidney
1.25
Nephrons consist of the ____ and a series of ____
Glomerulus; tubules
Filtering if blood starts in the ____ and continues in the tubules
Glomerulus
The glomerulus is a spherical mass of ____
Capillaries
The function of the glomerulus is to produce _____
Ultrafiltrate
Ultrafiltrate is the fluid produced after filtering the blood through the glomerulus into ___ ____
Bowman’s capsule
Ultrafiltrate contains…
-Water
-Sodium
-Potassium
-Urea
-Creatinine
-Glucose
Ultrafiltrate is free of ____
Protein
____ refers to something in the tubules going back into the blood (maybe the glomerulus removed too much water, so the tubules release more water back into the blood)
Reabsorption
____ refers to when a substance moves out of the vessels into the tubules to be released into the urine
Secretion
The ___ ___ selectively reabsorb substances from the ultrafiltrate and secrete substances into the urine
Renal tubules
The ____ tubule is responsible for the reabsorption of sodium, potassium, amino acids, glucose, bicarbonate, phosphorus, calcium, urea, and water
Proximal
The Loop of Henle is responsible for…
-Concentration of ultrafiltrate
-Reabsorption of water and sodium
The ____ tubule is responsible for the reabsorption of sodium, water, and bicarbonate, as well as the secretion of potassium, urea, hydrogen, ammonia, and some drugs
Distal
The ___ ___ is responsible for the reabsorption of water as well as the reabsorption or secretion of sodium, potassium, hydrogen, and ammonia
Collecting duct
The fluid leaving the collecting duct is ___
Urine
Urine enters the ___ ___ which narrows into 1 ureter per kidney
Renal pelvis
Each ____ carries urine into the bladder
Ureter
Urine accumulates and is then eliminated via the ____
Urethra
___ ___ is secreted by the pituitary in response to a decrease in total body H2O indicated by an increased serum osmolality
Antidiuretic hormone
Antidiuretic hormone makes the distal tubule and collecting duct more permeable to ___
H2O
Antidiuretic hormone increases ___ ___ and decreases ____ ____
Water reabsorption; urine volume
____ is secreted from the adrenal cortex in response to a decrease in blood pressure/blood volume
Aldosterone
Aldosterone ____ reabsorption of sodium in the distal tubules and collecting duct
Increases
Aldosterone increases water reabsorption and decreases ___ ___
Urine volume
What are three functions of the kidneys?
-Excretory
-Maintain homeostasis
-Endocrine
Kidneys excrete waste products like…
-Urea
-Creatinine
-Organic acids
How do kidneys maintain homeostasis?
-Sodium and water balance
-Electrolyte balance
-Acid-base balance
What substances are involved with the endocrine function of the kidneys?
-Renin
-Erythropoietin
-Vitamin D/calcitriol
____ is produced in the juxtaglomerular apparatus of the kidney in response to decreased blood pressure or decreased serum sodium
Renin
Renin reacts with ___ ___ in the blood to form ___ ___
Angiotensin I; angiotensin II
Roles of angiotensin II:
-Vasoconstrictor
-Stimulates the release of aldosterone
Erythropoietin is produced by the kidneys acts on stem cells of the bone marrow to stimulate the production of ___ ___ ___
Red blood cells
____ ___/___ is produced by the kidney and is the final site of vitamin D activation
Vitamin D3/calcitriol
Vitamin D3/calcitriol increases ____ absorption in the gut
Calcium
____ is a type of urinary tract infection that affects one or both kidneys
Pyelonephritis
Symptoms of pyelonephritis:
-Painful urination
-Hematuria
___ and ___ in cranberries and blueberries seem to inhibit the adherence of E-coli bacteria to the epithelial cells of the urinary tracts
Tannins and flavanols
____ is another name for kidney stones
Nephrolithiasis
Nephrolithiasis causes increased concentration of components in the urine, causing ____ to occur
Crystallization
What can kidney stones be made of?
-Calcium salts (80% of all stones)
-Uric acid
-Struvite (composed of magnesium ammonium phosphate and carbonate apatite)
-Cystine (least common)
Are kidney stones (nephrolithiasis) more common in men or women?
Women
Risk factors for the development of kidney stones:
-Low urine volume
-Family history
-Hypercalciuria
-Hyperoxaluria
-Obesity (increased excretion of calcium, oxalate, and uric acid)
Most kidney stones migrate down the ___ ___ and pass out of the body without medical intervention
Urinary tract
Some kidney stones can become lodged in the urinary tract, obstructing ___ ___ and causing acute pain
Urine flow
MNT for nephrolithiasis:
-Prevention: 2.5+ L of fluid per day to produce increased amounts of dilute urine
-Individualize dietary treatment based on composition of kidney stones
-Weight management
____ stones are the most common type of stone
Calcium
___% of stones are calcium oxalate, ___% calcium phosphate, and ___% calcium oxalate and calcium phosphate
60%, 10%, 10%
Hypercalciuria may be due to…
-Idiopathic hypercalciuria (unknown cause)
-Primary hyperparathyroidism
-Excess vitamin D intake
-Hyperthyroidism
-Glucocorticoid use
-Renal tubular acidosis
The relationship between ___ ___ and the risk of calcium stone formation is complex
Calcium intake
MNT for calcium stones:
-Adequate calcium intake (consume the DRI from food: 1000 mg if under age 50 and 1200 mg if over age 50; divide intake between 3 or more eating sessions)
-Avoid calcium supplements unless needed (calcium supplementation is associated with increased risk of stone formation- if needed, take with meals)
-Reduce sodium intake
Calcium oxalate stones can be caused by ____
Hyperoxaluria
Hyperoxaluria is caused by…
-High dietary oxalate intake
-GI malabsorptive disorders
-Genetic disorders
-Vitamin C supplements
With fat malabsorption, unabsorbed fat binds to calcium, which makes less calcium available to bind to ___, which leads to increased absorption of oxalates and less being removed in the feces
Oxalates
MNT for calcium oxalate stones:
-Avoid high-oxalate foods
-Consume with calcium-rich food or calcium supplements to reduce oxalate absorption
What foods are high in oxalates?
-Rhubarb, spinach, beets
-Strawberries
-Chocolate
-Wheat bran and whole-grain wheat products
-Nuts (almonds, peanuts, or pecans)
-Beets
-Tea (green or black)
-High doses of turmeric
___ ___ is a kidney disorder characterized by the loss of the glomerular barrier to protein
Nephrotic syndrome
Clinical manifestations of nephrotic syndrome:
-Hypoalbuminemia
-Edema
-High blood pressure
-Hypercholesterolemia
Nephrotic syndrome can be caused by…
-Diabetes
-Systemic lupus erythematosus
-Amyloidosis
-Glomerulonephritis (inflammation of the glomerulus)
Nephrotic syndrome can be acute or chronic and progress to ___ ___ ___
Chronic kidney disease
MNT for nephrotic syndrome:
-Dietary protein level remains controversial, but it is recommended 0.8-1.0 g/kg IBW
-35 kcal/kg IBW (to spare protein)
-2 g sodium restriction
-Low SFA/trans-fat diet
0.8-1 gram of protein per kilogram of IBW is believed to decrease renal damage without reducing ___ ___
Serum albumin
___ ___ ___ is also known as acute renal failure
Acute Kidney Injury
Acute kidney injury is characterized by a sudden decrease in ___ ____ ___
Glomerular filtration rate
Acute kidney injury causes an accumulation of ___ ___ in the blood
Nitrogenous wastes
Acute kidney injury can last a few days to ___ ___
Several weeks
What are the three categories of acute kidney injury?
-Pre-renal
-Intrinsic
-Post-renal
Preneal acute kidney injury is caused by ___ ____
Hypoperfused kidneys
Prerenal acute kidney injury occurs with…
-Dehydration
-Hypovolemia
-Hypotension
Intrinsic acute kidney injury is caused by diseases within the ___ ____
Renal parenchyma
___ ___ ___ is the most common cause of intrinsic acute kidney injury
Acute tubular necrosis
Acute tubular necrosis may develop from…
-Prerenal ischemia
-Use of nephrotoxic drugs or dyes
-Trauma
-Septicemia
Postrenal acute kidney injury is caused by obstruction in urine flow from various conditions including…
-Bladder and prostate cancer
-Nephrolithiasis
-Urethral occlusion
-BPH (benign prostatic hypertrophy)
What are the three phases of acute kidney injury?
-Oliguric phase
-Diuretic phase
-Recovery phase
In the oliguric phase, someone has low urine output of less than ___ mL/d
500
In the oliguric phase, someone has increased serum…
-BUN
-Creatinine
-Potassium
-Phosphorus
-Magnesium
In the diuretic phase of acute kidney injury, there is increased urine output at ___-___% of normal
150-200%
During the diuretic phase of acute kidney injury, someone is at an increased risk of ____
Dehydration
In the recovery phase of acute kidney injury, renal function normalizes and this generally occurs ___-___ weeks after the injury is corrected
2-3
Clinical manifestations of acute kidney injury:
-Azotemia
-Metabolic acidosis
-Hyperkalemia
Azotemia is a buildup of nitrogenous waste products (urea, uric acid, and ammonia) in the blood causing ____
Uremia
Uremia is a clinical syndrome caused by high levels of ___ ___ ___ in the blood
Nitrogenous waste products
Symptoms of uremia include…
-Malaise
-Weakness
-N/V
-Muscle cramps
-Itching
-Dysgeusia
-Neurological impairment
Goals of treatment of acute kidney injury:
-Control accumulation of uremic toxins
-Improve fluid and electrolyte imbalances
Treatment of acute kidney injury includes…
-Correcting underlying causes
-Possible intermittent hemodialysis or continuous renal replacement therapy
Continuous renal replacement therapy is used for ___ ___ patients
Critically ill
One example of continuous renal replacement therapy is ___ ___ ___
Continuous venovenous hemodialysis
What does continuous venovenous hemodialysis remove from the blood?
-Water
-Electrolytes
-Waste products
____ loss in an issue with continuous venovenous hemodialysis (can lose 10-15 grams of amino acids per day)
Protein
Those on continuous venovenous hemodialysis can absorb ___-___% of dextrose from dialysis, which is around 500 kcal per day
35-45%
What are some nutritional issues with acute kidney injury?
-Hypercatabolic state (loss of LBM)
-Increased serum potassium phosphorus, and magnesium due to decreased renal clearance and increased muscle catabolism
Nutrition requirements during acute kidney injury are affected by…
-Degree of hypercatabolism
-Type of renal replacement therapy (if any)
Energy requirements for those with acute kidney injury:
25-40 kcal/kg IBW
Protein requirements for non-catabolic patients who are not on dialysis:
0.8-1.0 g/kg IBW
Protein requirements for someone with increased protein needs during acute kidney injury who is not on dialysis:
1.0-1.2 g/kg IBW
Protein requirements for someone on intermittent hemodialysis:
1.0-1.5 g/kg IBW/UBW
Protein requirements for someone on continuous renal replacement therapy or who are hypercatabolic:
1.5-2.5 g/kg IBW/UBW
If anuric and not on continuous renal replacement therapy, we should restric fluid intake to ___-___ L/day
1.1.2
During the diuretic phase of acute kidney injury, we should replace output plus ___ mL
500
Fluid restriction is usually not necessary on ___ ___ ___ ___
Continuous renal replacement therapy
With acute kidney injury, it is important to monitor ___ ___ values
Serum values
Sodium should be restricted to ___-___ grams per day in the oliguric phase; goal should be to replace losses in the diuretic phase
1.1-3.3 (2g is average)
Potassium should be restricted to ___-___ mEq/day in the oliguric phase of acute kidney injury; goal should be to replace losses in the diuretic phase
30-50
Phosphorus should be restricted to __-__ mg/kg per day during acute kidney injury
8-15
