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Advanced Medical Nutrition Therapy > MNT for Renal Disease Part 2 > Flashcards

MNT for Renal Disease Part 2 Flashcards

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USMLE® Step 1 flashcards
1
Q

Chronic Kidney Disease is also known as ___ ___ ____

A

Chronic Renal Failure

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2
Q

CKD is defined as either…

A

-Kidney damage
-GFR <60 ml/min/1.73 m2 for 3 or more months

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3
Q

CKD causes a ___ ___ in kidney function over time

A

Gradual decline

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4
Q

If detected early, ___ and ___ ___ may slow the progression

A

Medications and dietary changes

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5
Q

___ ___ ___ is the best measure of kidney function

A

Glomerular filtration rate (GFR)

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6
Q

GFR is used to categorize a patient regarding the ___ of chronic kidney disease

A

Stage

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7
Q

Glomerular filtration rate is calculated by the MD by using the patient’s…

A

-Serum creatinine level
-Age
-Race
-Body size
-Gender

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8
Q

Description and GFR for stage 1 of CKD:

A

-Kidney damage with normal GFR
-GFR: 90 or more

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9
Q

Description and GFR for stage 2 of CKD:

A

-Kidney damage with mild decrease in GFR
-GFR: 60-89

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10
Q

Description and GFR for stage 3 of CKD:

A

-Moderate decrease in GFR
-GFR: 30-59

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11
Q

Description and GFR for stage 4 of CKD:

A

-Severe decrease in GFR
-GFR: 15-29

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12
Q

Description and GFR for stage 5 of CKD:

A

-Kidney failure; End-Stage Renal Disease
-GFR: <15 or on dialysis

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13
Q

____ means inadequate urine output

A

Oliguria

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14
Q

___- <___ ml/day of urine output indicates oliguria

A

100 - <500

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15
Q

____ is the complete cessation of urine flow

A

Anuria

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16
Q

___ to <___ ml/day of urine output indicates anuria

A

0 to <100

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17
Q

What are common causes of CKD?

A

-Diabetes mellitus
-Hypertension
-Glomerulonephritis
-Polycystic kidney disease
-Systemic lupus erythematosus
-Repeated urinary infections
-Nephrotic syndrome

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18
Q

What are two signs/symptoms of CKD?

A

-Azotemia
-Uremia

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19
Q

Azotemia is the accumulation of abnormal quantities of ___ ____ in the blood

A

Nitrogenous waste

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20
Q

____ refers to physical signs and symptoms of azotemia

A

Uremia

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21
Q

What are symptoms of uremia?

A

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

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22
Q

What is a normal GFR?

A

90-120 mL/min/1.73 m2

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23
Q

Serum creatinine levels ____ with CKD

A

Increase

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24
Q

Daily production of creatinine depends on ___ ___ and is excreted by the kidneys

A

Muscle mass

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25
Q

Normal creatinine level for women:

A

0.5-1.1 mg/dL

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26
Q

Normal creatinine level for men:

A

0.6-1.2 mg/dL

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27
Q

Blood urea nitrogen levels ____ with CKD (but levels can change for reasons other than CKD)

A

Increase

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28
Q

Normal BUN level:

A

10-20 mg/dL

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29
Q

Medical treatment for CKD may include…

A

-Treating/managing underlying causes
-Dialysis (hemodialysis, peritoneal dialysis)
-Transplantation

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30
Q

Hemodialysis removed ___ and ___ ___ from the body

A

Waste, excess fluid

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31
Q

Hemodialysis usually requires ___ sessions per week for ___-___ hours each

A

3 sessions; 3-5 hours

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32
Q

With hemodialysis, blood passes through a ___ ___ to be filtered

A

Semipermeable membrane

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33
Q

Waste products are removed via ____

A

Diffusion

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34
Q

Water removal by hemodialysis is called ____ and is done with pumps that are connected to the dialysis machine

A

Ultrafiltration

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35
Q

The ____ is made of a collection of thousands of hollow plastic fibers inside a plastic cylinder

A

Dialyzer

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36
Q

What are three types of vascular access used for dialysis?

A

-Fistula
-Graft
-Catheter

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37
Q

An ____ ____ is made by sewing together an artery and a vein in the forearm

A

Arteriovenous fistula

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38
Q

An arteriovenous fistula allows for strong blood flow from the artery to make the vein ___ and ___

A

Larger and stronger

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39
Q

With an arteriovenous fistula, 2 needles are inserted into the fistula- one for ___ ___ and one for ___ ___ ___

A

Withdrawing blood; returning filtered blood

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40
Q

An arteriovenous fistula is the ____ access for long-term hemodialysis

A

Preferred

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41
Q

Arteriovenous fistulas are less prone to ___ or ___ ___ compared to other types of access

A

Infections; blood clots

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42
Q

Veins and arteries self-heal after each needle stick, so fistulas can last a ___ ___

A

Long time

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43
Q

An ___ ___ is a piece of tubing that is used to surgically attach an artery and a vein

A

Arteriovenous graft

44
Q

Those with arteriovenous grafts are more likely to have difficulty with ___ ___ because it is made from synthetic material

A

Blood clots

45
Q

Some arteriovenous grafts develop ___ because the material cannot self-heal after needed punctures (may cause graft failure)

A

Holes

46
Q

A catheter is placed in the neck or chest and inserted into a ___ ___

A

Central vein

47
Q

Catheters are for ___-___, ____ access

A

Short-term; temporary

48
Q

An advantage of a catheter is that it can be used the ___ ___

A

Same day

49
Q

Disadvantages of a catheter access:

A

-Most prone to infection
-Can accidentally be pulled out

50
Q

Advantages of hemodialysis:

A

-Patient involvement is minimal
-Treatment is controlled by trained staff

51
Q

Disadvantages of hemodialysis:

A

-Time-consuming
-Loss of protein (5-8 g per treatment)
-Fluctuations in serum levels of urea, potassium, phosphorus, and fluid

52
Q

Complications include…

A

-Hypotension
-Infections as access site
-Graft failure

53
Q

____ ____ is dialysis that uses the semi-permeable membrane of the peritoneum as the dialyzer

A

Peritoneal dialysis

54
Q

With peritoneal dialysis, a high ___ dialysate is infused into the peritoneal cavity via a surgically places catheter in order to create a concentration gradient

A

Dextrose

55
Q

With peritoneal dialysis, ___ ___ and ____ pass from the blood through the peritoneal membrane into the dialysis via diffusion

A

Waste products and electrolytes

56
Q

With peritoneal dialysis, water passes via ____

A

Osmosis

57
Q

Dialysate is then drained from the ___ ___

A

Peritoneal cavity

58
Q

Bags usually hold ___, ___ or ___ liters of dialysate

A

1.5, 2.0, 2.5

59
Q

What are three common strengths of dialysate?

A

-1.5% dextrose
-2.5% dextrose
-4.25% dextrose

60
Q

High concentrations of dextrose is used if a large amount of ___ needs to be removed

A

Water

61
Q

What are two types of peritoneal dialysis?

A

-Continuous ambulatory peritoneal dialysis (CAPD)
-Continuous cyclic peritoneal dialysis (CCPD)

62
Q

Continuous ambulatory peritoneal dialysis is performed using ___-___ technology

A

Gravity-based

63
Q

Continuous cycle peritoneal dialysis uses a machine called a ____ for installation and drainage of the dialysis solution

A

Cycler

64
Q

Steps for performing continuous ambulatory peritoneal dialysis:

A
  1. Dialysate enters the peritoneal cavity, called “fill”
  2. While fluid dwells in the peritoneal cavity, extra fluid and wastes are drawn out of the blood and into the dialysate fluid
  3. After about 3-5 hours the dialysis fluid is drained, called “drain” and replaced by fresh fluid
65
Q

Peritoneal dialysis is typically performed __-___ times per day

A

4-6

66
Q

Advantages of peritoneal dialysis:

A

-Dialysis is done daily (less fluctuations in serum levels of urea)
-Home-based treatment
-More liberal diet
-May contribute to a more flexible lifestyle

67
Q

Disadvantages of peritoneal dialysis:

A

-Protein losses of 10-20 g/day
-Dextrose can be absorbed by the dialysate and contribute, on average, 400-800 kcal/day (causes weight gain and poorly controlled diabetes)

68
Q

A complication of peritoneal dialysis is ___ which can be severe

A

Peritonitis

69
Q

Studies have shown that patients who are not adequately dialyzed have an increased risk of ___ and ____

A

Morbidity and mortality

70
Q

___ ___ ____ is a measurement of reduction of urea that occurs during a dialysis treatment

A

Urea Reduction Ratio

71
Q

Urea reduction ratio can be calculated with what formula?

A

(predialysis BUN - postdialysis BUN) / predialysis BUN

72
Q

Someone would be well-dialyzed if there is a reduction in urea by >___%

A

65

73
Q

Complications of CKD:

A

-Alterations in fluid volume (hypervolemia)
-Electrolyte abnormalities (sodium, potassium, and phosphorus)
-Hypertension
-Metabolic acidosis
-Secondary hyperparathyroidism
-Glucose intolerance

74
Q

What type of anemia may be caused by CKD?

A

Normochromic, normocytic

75
Q

Normochromic, normocytic anemia is caused by…

A

-Inability to produce erythropoietin
-Increased destruction of red blood cells due to circulating uremic waste products

76
Q

Signs/symptoms of normocytic, normochromic anemia include…

A

-Decreased serum hemoglobin and hematocrit
-Fatigue, SOB, pallor, lightheadedness

77
Q

To manage amemia, you can use ___ ___ ___

A

Human Recombinant Erythropoietin (EPO)

78
Q

Drug nutrient interaction with human recombinant erythropoietin (EPO):

A

Increases need for iron for production of red blood cells

79
Q

With EPO, many people are given IV iron; some examples are:

A

-Iron dextran (Infed)
-Iron gluconate (Ferrlecit)
-Iron sucrose (Venofer)

80
Q

Iron stores should be measured monthly when on EPO, and we should monitor ___ ___

A

Serum ferritin

81
Q

Goal serum ferritin should be over ___ ng/mL but under ____ ng/mL for hemodialysis patients receiving EPO

A

300; 800

82
Q

Signs and symptoms renal osteodystrophy:

A

-Bone pain
-Pathologic fractures
-Metastatic calcification

83
Q

The first step in the pathophysiology of renal osteodystrophy:

A

As renal function declines, the kidneys cannot excrete phosphorus load, leading to hyperphosphatemia

84
Q

The second step in the pathophysiology of renal osteodystrophy:

A

Serum calcium levels decline due to a decrease in 1,25 dihydroxyvitamin D3, which leads to a decrease in intestinal absorption of calcium

85
Q

The third step in the pathophysiology of renal osteodystrophy:

A

Low serum calcium levels trigger the release of parathyroid hormone, leading to bone resorption of calcium

86
Q

The fourth step in the pathophysiology of renal osteodystrophy:

A

An increase in calcium phosphorus product leads to calcification of soft tissues

87
Q

Serum calcium x serum phosphorus > ____ mg2/dL2 would lead to calcifications

A

70

88
Q

The National Kidney Foundation’s goal is to keep calcium x phosphorus product under ____ mg2/dL2

A

55

89
Q

MNT for renal osteodystrophy:

A

-Calcium: adjust total intake from food, supplements, and calcium-based phosphorus binds to avoid hypercalcemia
-Active vitamin D supplementation: Rocaltrol
-Decrease dietary phosphorus intake to 800-1200 mg/d

90
Q

Calcium supplements should be ___ ___

A

Calcium carbonate

91
Q

For renal osteodystrophy, calcium supplements should be given on an empty stomach ___ meals and at bedtime

A

Between

92
Q

What are some examples of phosphate-binding medications:

A

-MOA
-Calcium-containing binders
-Sevelamer hydrochloride (Renagel)
-Ferric citrate

93
Q

MOA bind with phosphorus in the ___

A

Gut

94
Q

What are two examples of calcium-containing binders?

A

-Calcium Acetate (PhosLo)
-Calcium Carbonate (Oscal)

95
Q

What is a possible complication of calcium-containing binders?

A

Hypercalcemia

96
Q

Sevelamer hydrochloride (Renagel) lowers phosphorus without increasing ____

A

Calcium

97
Q

Ferric citrate is an ___-___ binder

A

Iron-based

98
Q

Phosphate binders should be taken ___ ___

A

With meals

99
Q

There is a high prevalence of ____ ___ is dialysis patients

A

Cardiovascular disease

100
Q

__ __ ___ is commonly seen secondary to hypertension

A

Congestive heart failure

101
Q

Accelerated atherosclerosis can lead to ___ ___ ___

A

Coronary heart disease

102
Q

Non-traditional risk factors for coronary heart disease:

A

-Inflammation
-Oxidative stress
-Abnormalities of lipoprotein metabolism
-Vascular calcification

103
Q

MNT for cardiovascular disease:

A

Mediterranean diet pattern may improve lipid profiles

104
Q

Other complications of CKD:

A

-Increased bleeding tendency
-Impaired leukocyte function (increased susceptibility to infections
-Neurologic manifestations (insomnia, difficulty concentrating, peripheral neuropathy, restless leg syndrome, seizures, encephalopathy)
-Malnutrition

105
Q

____ is one of the most common complications of CKD, especially for those on dialysis

A

Malnutrition

106
Q

Factors leading to malnutrition:

A

-N/V
-Taste alterations
-Anorexia
-Fatigue
-Multiple dietary restrictions
-Inadequate intake due to depression, financial challenges, lack of family support, missed meals due to dialysis, inability to obtain or prepare food
-Food-drug interactions
-Protein loss from dialysis treatment
-Inflammatory response (increases protein requirements)

Advanced Medical Nutrition Therapy (14 decks)

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