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Advanced Medical Nutrition Therapy > MNT for Renal Disease Part 1 > Flashcards

MNT for Renal Disease Part 1 Flashcards

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USMLE® Step 1 flashcards
1
Q

The ___ ___ brings oxygenated blood to the kidneys

A

Renal artery

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2
Q

The ___ ___ takes deoxygenated blood from the kidneys back to the heart

A

Renal vein

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3
Q

____ are the functional unit of the kidney and act as the “filter”

A

Nephrons

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4
Q

There are ____ million nephrons per kidney

A

1.25

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5
Q

Nephrons consist of the ____ and a series of ____

A

Glomerulus; tubules

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6
Q

Filtering if blood starts in the ____ and continues in the tubules

A

Glomerulus

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7
Q

The glomerulus is a spherical mass of ____

A

Capillaries

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8
Q

The function of the glomerulus is to produce _____

A

Ultrafiltrate

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9
Q

Ultrafiltrate is the fluid produced after filtering the blood through the glomerulus into ___ ____

A

Bowman’s capsule

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10
Q

Ultrafiltrate contains…

A

-Water
-Sodium
-Potassium
-Urea
-Creatinine
-Glucose

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11
Q

Ultrafiltrate is free of ____

A

Protein

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12
Q

____ 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)

A

Reabsorption

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13
Q

____ refers to when a substance moves out of the vessels into the tubules to be released into the urine

A

Secretion

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14
Q

The ___ ___ selectively reabsorb substances from the ultrafiltrate and secrete substances into the urine

A

Renal tubules

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15
Q

The ____ tubule is responsible for the reabsorption of sodium, potassium, amino acids, glucose, bicarbonate, phosphorus, calcium, urea, and water

A

Proximal

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16
Q

The Loop of Henle is responsible for…

A

-Concentration of ultrafiltrate
-Reabsorption of water and sodium

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17
Q

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

A

Distal

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18
Q

The ___ ___ is responsible for the reabsorption of water as well as the reabsorption or secretion of sodium, potassium, hydrogen, and ammonia

A

Collecting duct

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19
Q

The fluid leaving the collecting duct is ___

A

Urine

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20
Q

Urine enters the ___ ___ which narrows into 1 ureter per kidney

A

Renal pelvis

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21
Q

Each ____ carries urine into the bladder

A

Ureter

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22
Q

Urine accumulates and is then eliminated via the ____

A

Urethra

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23
Q

___ ___ is secreted by the pituitary in response to a decrease in total body H2O indicated by an increased serum osmolality

A

Antidiuretic hormone

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24
Q

Antidiuretic hormone makes the distal tubule and collecting duct more permeable to ___

A

H2O

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25
Q

Antidiuretic hormone increases ___ ___ and decreases ____ ____

A

Water reabsorption; urine volume

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26
Q

____ is secreted from the adrenal cortex in response to a decrease in blood pressure/blood volume

A

Aldosterone

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27
Q

Aldosterone ____ reabsorption of sodium in the distal tubules and collecting duct

A

Increases

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28
Q

Aldosterone increases water reabsorption and decreases ___ ___

A

Urine volume

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29
Q

What are three functions of the kidneys?

A

-Excretory
-Maintain homeostasis
-Endocrine

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30
Q

Kidneys excrete waste products like…

A

-Urea
-Creatinine
-Organic acids

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31
Q

How do kidneys maintain homeostasis?

A

-Sodium and water balance
-Electrolyte balance
-Acid-base balance

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32
Q

What substances are involved with the endocrine function of the kidneys?

A

-Renin
-Erythropoietin
-Vitamin D/calcitriol

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33
Q

____ is produced in the juxtaglomerular apparatus of the kidney in response to decreased blood pressure or decreased serum sodium

A

Renin

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34
Q

Renin reacts with ___ ___ in the blood to form ___ ___

A

Angiotensin I; angiotensin II

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35
Q

Roles of angiotensin II:

A

-Vasoconstrictor
-Stimulates the release of aldosterone

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36
Q

Erythropoietin is produced by the kidneys acts on stem cells of the bone marrow to stimulate the production of ___ ___ ___

A

Red blood cells

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37
Q

____ ___/___ is produced by the kidney and is the final site of vitamin D activation

A

Vitamin D3/calcitriol

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38
Q

Vitamin D3/calcitriol increases ____ absorption in the gut

A

Calcium

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39
Q

____ is a type of urinary tract infection that affects one or both kidneys

A

Pyelonephritis

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40
Q

Symptoms of pyelonephritis:

A

-Painful urination
-Hematuria

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41
Q

___ and ___ in cranberries and blueberries seem to inhibit the adherence of E-coli bacteria to the epithelial cells of the urinary tracts

A

Tannins and flavanols

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42
Q

____ is another name for kidney stones

A

Nephrolithiasis

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43
Q

Nephrolithiasis causes increased concentration of components in the urine, causing ____ to occur

A

Crystallization

44
Q

What can kidney stones be made of?

A

-Calcium salts (80% of all stones)
-Uric acid
-Struvite (composed of magnesium ammonium phosphate and carbonate apatite)
-Cystine (least common)

45
Q

Are kidney stones (nephrolithiasis) more common in men or women?

A

Women

46
Q

Risk factors for the development of kidney stones:

A

-Low urine volume
-Family history
-Hypercalciuria
-Hyperoxaluria
-Obesity (increased excretion of calcium, oxalate, and uric acid)

47
Q

Most kidney stones migrate down the ___ ___ and pass out of the body without medical intervention

A

Urinary tract

48
Q

Some kidney stones can become lodged in the urinary tract, obstructing ___ ___ and causing acute pain

A

Urine flow

49
Q

MNT for nephrolithiasis:

A

-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

50
Q

____ stones are the most common type of stone

A

Calcium

51
Q

___% of stones are calcium oxalate, ___% calcium phosphate, and ___% calcium oxalate and calcium phosphate

A

60%, 10%, 10%

52
Q

Hypercalciuria may be due to…

A

-Idiopathic hypercalciuria (unknown cause)
-Primary hyperparathyroidism
-Excess vitamin D intake
-Hyperthyroidism
-Glucocorticoid use
-Renal tubular acidosis

53
Q

The relationship between ___ ___ and the risk of calcium stone formation is complex

A

Calcium intake

54
Q

MNT for calcium stones:

A

-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

55
Q

Calcium oxalate stones can be caused by ____

A

Hyperoxaluria

56
Q

Hyperoxaluria is caused by…

A

-High dietary oxalate intake
-GI malabsorptive disorders
-Genetic disorders
-Vitamin C supplements

57
Q

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

A

Oxalates

58
Q

MNT for calcium oxalate stones:

A

-Avoid high-oxalate foods
-Consume with calcium-rich food or calcium supplements to reduce oxalate absorption

59
Q

What foods are high in oxalates?

A

-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

60
Q

___ ___ is a kidney disorder characterized by the loss of the glomerular barrier to protein

A

Nephrotic syndrome

61
Q

Clinical manifestations of nephrotic syndrome:

A

-Hypoalbuminemia
-Edema
-High blood pressure
-Hypercholesterolemia

62
Q

Nephrotic syndrome can be caused by…

A

-Diabetes
-Systemic lupus erythematosus
-Amyloidosis
-Glomerulonephritis (inflammation of the glomerulus)

63
Q

Nephrotic syndrome can be acute or chronic and progress to ___ ___ ___

A

Chronic kidney disease

64
Q

MNT for nephrotic syndrome:

A

-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

65
Q

0.8-1 gram of protein per kilogram of IBW is believed to decrease renal damage without reducing ___ ___

A

Serum albumin

66
Q

___ ___ ___ is also known as acute renal failure

A

Acute Kidney Injury

67
Q

Acute kidney injury is characterized by a sudden decrease in ___ ____ ___

A

Glomerular filtration rate

68
Q

Acute kidney injury causes an accumulation of ___ ___ in the blood

A

Nitrogenous wastes

69
Q

Acute kidney injury can last a few days to ___ ___

A

Several weeks

70
Q

What are the three categories of acute kidney injury?

A

-Pre-renal
-Intrinsic
-Post-renal

71
Q

Preneal acute kidney injury is caused by ___ ____

A

Hypoperfused kidneys

72
Q

Prerenal acute kidney injury occurs with…

A

-Dehydration
-Hypovolemia
-Hypotension

73
Q

Intrinsic acute kidney injury is caused by diseases within the ___ ____

A

Renal parenchyma

74
Q

___ ___ ___ is the most common cause of intrinsic acute kidney injury

A

Acute tubular necrosis

75
Q

Acute tubular necrosis may develop from…

A

-Prerenal ischemia
-Use of nephrotoxic drugs or dyes
-Trauma
-Septicemia

76
Q

Postrenal acute kidney injury is caused by obstruction in urine flow from various conditions including…

A

-Bladder and prostate cancer
-Nephrolithiasis
-Urethral occlusion
-BPH (benign prostatic hypertrophy)

77
Q

What are the three phases of acute kidney injury?

A

-Oliguric phase
-Diuretic phase
-Recovery phase

78
Q

In the oliguric phase, someone has low urine output of less than ___ mL/d

A

500

79
Q

In the oliguric phase, someone has increased serum…

A

-BUN
-Creatinine
-Potassium
-Phosphorus
-Magnesium

80
Q

In the diuretic phase of acute kidney injury, there is increased urine output at ___-___% of normal

A

150-200%

81
Q

During the diuretic phase of acute kidney injury, someone is at an increased risk of ____

A

Dehydration

82
Q

In the recovery phase of acute kidney injury, renal function normalizes and this generally occurs ___-___ weeks after the injury is corrected

A

2-3

83
Q

Clinical manifestations of acute kidney injury:

A

-Azotemia
-Metabolic acidosis
-Hyperkalemia

84
Q

Azotemia is a buildup of nitrogenous waste products (urea, uric acid, and ammonia) in the blood causing ____

A

Uremia

85
Q

Uremia is a clinical syndrome caused by high levels of ___ ___ ___ in the blood

A

Nitrogenous waste products

86
Q

Symptoms of uremia include…

A

-Malaise
-Weakness
-N/V
-Muscle cramps
-Itching
-Dysgeusia
-Neurological impairment

87
Q

Goals of treatment of acute kidney injury:

A

-Control accumulation of uremic toxins
-Improve fluid and electrolyte imbalances

88
Q

Treatment of acute kidney injury includes…

A

-Correcting underlying causes
-Possible intermittent hemodialysis or continuous renal replacement therapy

89
Q

Continuous renal replacement therapy is used for ___ ___ patients

A

Critically ill

90
Q

One example of continuous renal replacement therapy is ___ ___ ___

A

Continuous venovenous hemodialysis

91
Q

What does continuous venovenous hemodialysis remove from the blood?

A

-Water
-Electrolytes
-Waste products

92
Q

____ loss in an issue with continuous venovenous hemodialysis (can lose 10-15 grams of amino acids per day)

A

Protein

93
Q

Those on continuous venovenous hemodialysis can absorb ___-___% of dextrose from dialysis, which is around 500 kcal per day

A

35-45%

94
Q

What are some nutritional issues with acute kidney injury?

A

-Hypercatabolic state (loss of LBM)
-Increased serum potassium phosphorus, and magnesium due to decreased renal clearance and increased muscle catabolism

95
Q

Nutrition requirements during acute kidney injury are affected by…

A

-Degree of hypercatabolism
-Type of renal replacement therapy (if any)

96
Q

Energy requirements for those with acute kidney injury:

A

25-40 kcal/kg IBW

97
Q

Protein requirements for non-catabolic patients who are not on dialysis:

A

0.8-1.0 g/kg IBW

98
Q

Protein requirements for someone with increased protein needs during acute kidney injury who is not on dialysis:

A

1.0-1.2 g/kg IBW

99
Q

Protein requirements for someone on intermittent hemodialysis:

A

1.0-1.5 g/kg IBW/UBW

100
Q

Protein requirements for someone on continuous renal replacement therapy or who are hypercatabolic:

A

1.5-2.5 g/kg IBW/UBW

101
Q

If anuric and not on continuous renal replacement therapy, we should restric fluid intake to ___-___ L/day

A

1.1.2

102
Q

During the diuretic phase of acute kidney injury, we should replace output plus ___ mL

A

500

103
Q

Fluid restriction is usually not necessary on ___ ___ ___ ___

A

Continuous renal replacement therapy

104
Q

With acute kidney injury, it is important to monitor ___ ___ values

A

Serum values

105
Q

Sodium should be restricted to ___-___ grams per day in the oliguric phase; goal should be to replace losses in the diuretic phase

A

1.1-3.3 (2g is average)

106
Q

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

A

30-50

107
Q

Phosphorus should be restricted to __-__ mg/kg per day during acute kidney injury

A

8-15

Advanced Medical Nutrition Therapy (14 decks)

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