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FN 125 LE3 > MNT for Renal Diseases > Flashcards

MNT for Renal Diseases Flashcards

1
Q

3 main functions of the kidneys

A

Homeostasis
Excretion of metabolic wastes
Endocrine

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2
Q

What are the homeostatic functions of the kidneys?

A

Water regulation
Fluid-electrolyte balance
Acid-base balance

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3
Q

Describe the mechanism for the kidney’s mechanism of action for water regulation?

A

Decreased plasma volume —> posterior pituitary gland releases vasopressin —> kidney’s collecting ducts will increase its tubular permeability and reabsorbs water —> water is retained; excretion decreases

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4
Q

normal pH range of the body

A

7.35-7.45

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5
Q

Kidneys secrete H+ ions that will react with what acid?

What will they form?

A

Carbonic acid

Bicarbonate

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6
Q

This substance released by the kidneys increases the pH to achieve acid-base balance?

A

Sodium bicarbonate (NaHCO3)

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7
Q

This hormone is responsible for sodium retention.

A

Aldosterone

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8
Q

Function of vasopressin

A

Water retention

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9
Q

A glycoprotein hormone naturally produced by the peritubular cells of the kidney that stimulates red blood cell production

A

Erythropoietin

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10
Q

Describe the RAAS.

A

Decreased blood volume, hypotension, and low sodium —> JGA —> renin —> angiotensinogen is activated —> angiotensin I —> angiotensin II —> vasoconstriction and adrenal release of aldosterone (Na and water retention) —> increased blood pressure and blood volume

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11
Q

True or False. The kidney is the site for vitamin D activation.

A

True

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12
Q

Produces filtrate from the blood.

A

Glomerulus

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13
Q

The PCT reabsorbs:

A
  • two-thirds of filtrate
  • glucose and amino acids
  • major fraction of sodium, bicarbonate, Ca, P, K through active transport
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14
Q

What are the two parts of the loop of Henle and their functions?

A

Descending limb: only water reabsorption
Ascending limb: only Na reabsorption

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15
Q

This part of the nephron concentrates urine when the body needs to conserve water, as it is permeable to water only in the presence of ADH

A

DCT

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16
Q

The permeability of the collecting ducts is regulated by what hormone?

A

Aldosterone and ADH

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17
Q

This is where urine is formed.

A

Collecting ducts

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18
Q

Preferred method in calculating IBW.

A

Hamwi

IBW = Baseline weight + (5 lb or 6 lb x additional inches)

Male = 106 lbs
Female = 100 lbs

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19
Q

Standard BW is derived from

A

NHANES II data

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20
Q

DBW is based on

A

BMI, Tannhauser’s

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21
Q

Formula of Adjusted BW

A

Adj. BW = ideal BW + [(actual BW - ideal BW) x 0.25)]

or adj. BW = edema-free BW + [(standard BW - edema-free BW) x 0.25)]

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22
Q

Analogous to estimated dry weight in the patient being treated by renal replacement therapies.

A

Edema-free body weight

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23
Q

Formula for %usual BW

A

%usual BW = [(usual BW - current BW)/usual BW] x 100

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24
Q

Unit of GFR

A

ml/min/1.73 m2

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25
Q

Approximate GFR for men and women

A

Men = 130 ml/min/1.73 m2
Women = 120 ml/min/1.73 m2

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26
Q

Renal Diagnostics: Impaired GF

A

Creatinine

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27
Q

Renal Diagnostics: impaired GF and loss of tubular ability to reabsorb and excrete leading to alterations in the plasma

A

BUN
Serum uric acid

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28
Q

Renal Diagnostics: the rate at which substances are cleared from the plasma by the glomeruli

A

GFR

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29
Q

Renal Diagnostics: indicates filtration is inefficient, allowing large molecules to pass by the glomerulus

A

Erythrocytes, glucose, protein, and microorganisms in the urine

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30
Q

Renal Diagnostics: acid-base balance

A

pH of urine

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31
Q

Renal Diagnostics: diminished urine formation may be associated with decreased GF due to renal disease or obstruction

A

Urine volume

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32
Q

Renal Diagnostics: indicates that the tubules cannot concentrate the urine.

A

Specific gravity of urine

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33
Q

Formula for GFR

A

Cockcroft-Gault formula

GFR = [(140 - age) x BW x constant] / 72 x serum creatinine levels

0.85 for female

eGFR = [(140 - age) x BW x constant] / serum creatinine

Female = 1.04
Male = 1.23

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34
Q

Common types of nephrolithiasis

A

Calcium oxalate
Uric acid

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35
Q

Foods that are high purine sources

A

Organ meats
Shellfish

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36
Q

High purine intake leads to ahigher production of what substance?

A

Monosodium urate. This substance then leads to the production of kidney stones.

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37
Q

Dietary management of nephrolithiasis

A

Based on what type of stones - control Ca or purine
Low salt
High F and V
Increased fluid intake
Reduce SSBs

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38
Q

Dietary management specific to calcium oxalate stones

A

Limit oxalate intake to 50-60 mg/d
Avoid foods that increase urinary oxalate

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39
Q

Give examples of food that increase urinary oxalate

A

Beets, chocolate, cola, coffee/tea, nuts, berries, wheat bran, spinach, rhubarb

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40
Q

Nutritional management for UTI

A

Increased fluid intake

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41
Q

Also called glomerulonephritis

A

Nephritic syndrome

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42
Q

Inflammation of the capillary loops of the glomerulus

A

Nephritic syndrome

43
Q

Causes of nephritic syndrome

A

Streptococcal infection, primary or secondary kidney diseases, immune disorders, hereditary disorders, and drugs

44
Q

Symptoms of nephritic syndrome

A

Hematuria
Proteinuria
HPN
mild loss of kidney function

45
Q

Nephritic syndrome may be ______ or ________.

A

Acute or chronic

46
Q

Nutritional goals for nephritic syndrome

A

1) Prevent edema
2) Restrict sodium - HPN
3) Control hematuria

47
Q

Sodium restrictions for nephritic syndrome

A

Severe: 250 g: low-Na milk, limited animal CHON, no salt and processed foods

Strict: 500 g: omit processed foods, limit milk

Mild: 1 g: eliminate salted foods, no salt during cooking (prevent edema and HPN)

Mild: 2-3 g: Omitted/calculated salt at the table, limit salt during cooking (prevent edema and HPN, for those under steroid therapy)

No added salt: >3-4 g or 4-5 g: same with mild

48
Q

Fluid recommendations for nephritic syndrome

A

500 ml/d + urine output from the previous day

49
Q

Sodium recommendations for nephritic syndrome

A

<2000 mg/d

50
Q

CHON intake for nephritic syndrome

A

40-70 g/d

51
Q

Abnormal condition that is marked by the deficiency of albumin in the blood and its excretion in the urine

Altered permeability of the glomerular basement membranes

A

Nephrotic syndrome

52
Q

Symptoms of nephrotic syndrome

A

Proteinuria
Edema
Hyperlipidemia

53
Q

Associated with the increased risk of atherosclerosis

A

Nephrotic syndrome

54
Q

Causes of nephrotic syndrome

A

Glomerulonephritis
Diabetic nephropathy
Autoimmune diseases
Drug toxicity

55
Q

Nutritional goals for nephrotic syndrome

A

1) Minimize the effects of proteinuria, edema, and hyperlipidemia
2) Replace lost nutrients
3) Reduce the risk of further renal progression and atherosclerosis

56
Q

Recommended energy for nephrotic syndrome

A

35 kcal/kg/day

57
Q

Recommended protein for nephrotic syndrome

A

0.6-0.8 g/kg/d + protein loss
0.8-1.0 g/d

58
Q

Fluid recommendation for nephrotic syndrome

A

Depends on the presence of edema

59
Q

Sodium recommendations for nephrotic syndrome

A

less than or equal to 2,000 mg/d or 1-2 g/d

60
Q

Fat recommendations for nephrotic syndrome

A

30% of TER
10% PUFA
200 - 300 mg/d of cholesterol

61
Q

Carbohydrate recommendations for nephrotic syndrome

A

High in complex carbohydrates

62
Q

Phosphorous recommendations for nephrotic syndrome

A

<12 mg/kg/d

63
Q

Calcium recommendations for nephrotic syndrome

A

1000-1500 mg per day or no more than 2000 mg with supplementation

64
Q

Important vitamins and minerals for nephrotic syndrome

A

Ca, Vitamin D, P, Zn, Fe

65
Q

Sudden decrease in GFR and an alteration in the kidney’s ability to excrete waste

Reversible

A

Acute renal failure

66
Q

Symptoms of ARF

A

Oliguria
Fluid and electrolyte imbalance
Uremia

67
Q

Causes of ARF

A

Inadequate renal perfusion
Diseases within renal parenchyma
Obstruction

68
Q

Nutritional goals for ARF

A

To achieve and maintain optimum nutritional status
To reduce uremic symptoms
To maintain normal fluid and electrolyte imbalance

69
Q

Energy recommendations for ARF

A

30-35 kcal/kg/day

70
Q

Protein recommendations for ARF

A

0.25 - 0.50 g/kg/d

71
Q

Sodium recommendations for ARF

A

2g/day; 1 g/d if oliguric

72
Q

Potassium recommendation for ARF

A

Limit to 25-50 mEq until urine volume increases during recovery phase

73
Q

Fluid recommendations for ARF

A

500 ml/d + urine output of the day

74
Q

Syndrome in which progressive loss of kidney function occurs

Irreversible

A

CKD

75
Q

May progress to end-stage renal disease resulting in renal replacement therapy or transplant

A

CKD

76
Q

Onset of CKD is not apparent until ___-___% of renal function is lost

A

50-70

77
Q

Risk factors of CKD

A

Proteinuria
Ethnicity
Gender
Smoking
Heavy consumption of non-narcotic analgesics

78
Q

Causes of CKD

A

Diabetes
Hypertension
Glomerulonephritis
Hereditary congenital and cystic kidney disease
Pyelonephritis
Tumor

79
Q

Symptoms of CKD

A

Decreased kidney function
Sodium retention and edema
Hypertension
Metabolic acidosis
K+ accumulation
Microcytic anemia
Renal osteodystrophy

80
Q

A renal replacement procedure that removes toxic and excessive by-products of metabolism from the blood

A

Dialysis

81
Q

Rinsing fluid that have varying ion and mineral composition

A

Dialysate

82
Q

Two kinds of dialysis. Differentiate

A

Hemodialysis - access through the arm; blood is pumped out of the body into an artificial kidney machine, returned to the body by tubes

Peritoneal dialysis - access through the abdomen; the inside lining of the abdomen acts as a natural filter

83
Q

Nutrition therapy goals for CKD stages 1 and 2

A

Focuses on the control of co-morbid conditions

Slows the progression of potential CVDs

Regular monitoring of biochemical indices

84
Q

Protein recommendations for CKD Stages 3 and 4

A

0.60-0.75 g/kg
>50% of HBV
GFR <25 ml/min

85
Q

Energy recommendations for CKD Stages 3 and 4

A

30-35%
Low cholesterol
<30% fat

86
Q

Phosphorus recommendations for CKD Stages 3 and 4

A

10-12 mg/g of CHON

87
Q

Sodium recommendations for CKD Stages 3 and 4

A

1-3 g

88
Q

Calcium recommendations for CKD Stages 3 and 4

A

1.0-1.5 g

89
Q

Fluid recommendations for CKD Stages 3 and 4

A

Maintain fluid balance

90
Q

Vitamins and minerals recommendations for CKD Stages 3 and 4

A

B complex (PDRI recommendation), individualized vitamin D, Fe, Zn

91
Q

Very common in dialysis patients

A

Malnutrition

92
Q

Causes of malnutrition in CKD

A

Inadequate food intake due to:
- anorexia caused by uremia
- altered taste
- emotional distress
- unpalatable diet

Loss of blood due to:
- GI bleeding
- frequent blood sampling
- blood lost during dialysis

Metabolic acidosis due to increased CHON metabolism

Endocrine disorders
- hyperparathyroidism
- hyperglucagonemia
- insulin resistance
- concurrent medications —> anorexia
- dialysis

93
Q

Energy, protein, and fat recommendations for HD and PD patients

A

Energy: 30-35%
Protein: 1.2 g/kg; 50% HBV
Fat: 25-35%
Cholesterol: <200 mg/day

94
Q

Fiber recommendations for HD and PD patients

A

20-30 g/d

95
Q

Potassium recommendations for HD and PD patients

A

HD: 2-3 g
PD: ~3-4 g

96
Q

Sodium recommendations for HD and PD patients

A

HD: 2-3 g
PD: individualized

97
Q

Fluid intake recommendations for HD and PD patients

A

HD: 1 L + urine output
PD: Individualized

98
Q

Ca recommendations for HD and PD patients

A

1500 mg/d

99
Q

Phosphorus recommendations for HD and PD patients

A

800-1000 mg/d

100
Q

Post transplant management is divided into two periods:

A

Acute - first 8 weeks
Chronic - 9th week onwards

101
Q

Nutritional goal for acute phase of post-transplant

A

To manage the increased metabolic needs of the surgery.

102
Q

Nutritional goal for chronic phase of post-transplant

A

To include the management of co-morbidities

103
Q

Estimated weights of ascites

A

Minimal - 2.2 kg
Moderate - 6 kg
Severe - 14 kg

104
Q

Estimated weights of peripheral edema

A

Minimal - 1 kg
Moderate - 5 kg
Severe - 10 kg

FN 125 LE3 (5 decks)

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