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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
Approximate GFR for men and women
Men = 130 ml/min/1.73 m2 Women = 120 ml/min/1.73 m2
26
Renal Diagnostics: Impaired GF
Creatinine
27
Renal Diagnostics: impaired GF and loss of tubular ability to reabsorb and excrete leading to alterations in the plasma
BUN Serum uric acid
28
Renal Diagnostics: the rate at which substances are cleared from the plasma by the glomeruli
GFR
29
Renal Diagnostics: indicates filtration is inefficient, allowing large molecules to pass by the glomerulus
Erythrocytes, glucose, protein, and microorganisms in the urine
30
Renal Diagnostics: acid-base balance
pH of urine
31
Renal Diagnostics: diminished urine formation may be associated with decreased GF due to renal disease or obstruction
Urine volume
32
Renal Diagnostics: indicates that the tubules cannot concentrate the urine.
Specific gravity of urine
33
Formula for GFR
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
34
Common types of nephrolithiasis
Calcium oxalate Uric acid
35
Foods that are high purine sources
Organ meats Shellfish
36
High purine intake leads to ahigher production of what substance?
Monosodium urate. This substance then leads to the production of kidney stones.
37
Dietary management of nephrolithiasis
Based on what type of stones - control Ca or purine Low salt High F and V Increased fluid intake Reduce SSBs
38
Dietary management specific to calcium oxalate stones
Limit oxalate intake to 50-60 mg/d Avoid foods that increase urinary oxalate
39
Give examples of food that increase urinary oxalate
Beets, chocolate, cola, coffee/tea, nuts, berries, wheat bran, spinach, rhubarb
40
Nutritional management for UTI
Increased fluid intake
41
Also called glomerulonephritis
Nephritic syndrome
42
Inflammation of the capillary loops of the glomerulus
Nephritic syndrome
43
Causes of nephritic syndrome
Streptococcal infection, primary or secondary kidney diseases, immune disorders, hereditary disorders, and drugs
44
Symptoms of nephritic syndrome
Hematuria Proteinuria HPN mild loss of kidney function
45
Nephritic syndrome may be ______ or ________.
Acute or chronic
46
Nutritional goals for nephritic syndrome
1) Prevent edema 2) Restrict sodium - HPN 3) Control hematuria
47
Sodium restrictions for nephritic syndrome
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
Fluid recommendations for nephritic syndrome
500 ml/d + urine output from the previous day
49
Sodium recommendations for nephritic syndrome
<2000 mg/d
50
CHON intake for nephritic syndrome
40-70 g/d
51
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
Nephrotic syndrome
52
Symptoms of nephrotic syndrome
Proteinuria Edema Hyperlipidemia
53
Associated with the increased risk of atherosclerosis
Nephrotic syndrome
54
Causes of nephrotic syndrome
Glomerulonephritis Diabetic nephropathy Autoimmune diseases Drug toxicity
55
Nutritional goals for nephrotic syndrome
1) Minimize the effects of proteinuria, edema, and hyperlipidemia 2) Replace lost nutrients 3) Reduce the risk of further renal progression and atherosclerosis
56
Recommended energy for nephrotic syndrome
35 kcal/kg/day
57
Recommended protein for nephrotic syndrome
0.6-0.8 g/kg/d + protein loss 0.8-1.0 g/d
58
Fluid recommendation for nephrotic syndrome
Depends on the presence of edema
59
Sodium recommendations for nephrotic syndrome
less than or equal to 2,000 mg/d or 1-2 g/d
60
Fat recommendations for nephrotic syndrome
30% of TER 10% PUFA 200 - 300 mg/d of cholesterol
61
Carbohydrate recommendations for nephrotic syndrome
High in complex carbohydrates
62
Phosphorous recommendations for nephrotic syndrome
<12 mg/kg/d
63
Calcium recommendations for nephrotic syndrome
1000-1500 mg per day or no more than 2000 mg with supplementation
64
Important vitamins and minerals for nephrotic syndrome
Ca, Vitamin D, P, Zn, Fe
65
Sudden decrease in GFR and an alteration in the kidney’s ability to excrete waste Reversible
Acute renal failure
66
Symptoms of ARF
Oliguria Fluid and electrolyte imbalance Uremia
67
Causes of ARF
Inadequate renal perfusion Diseases within renal parenchyma Obstruction
68
Nutritional goals for ARF
To achieve and maintain optimum nutritional status To reduce uremic symptoms To maintain normal fluid and electrolyte imbalance
69
Energy recommendations for ARF
30-35 kcal/kg/day
70
Protein recommendations for ARF
0.25 - 0.50 g/kg/d
71
Sodium recommendations for ARF
2g/day; 1 g/d if oliguric
72
Potassium recommendation for ARF
Limit to 25-50 mEq until urine volume increases during recovery phase
73
Fluid recommendations for ARF
500 ml/d + urine output of the day
74
Syndrome in which progressive loss of kidney function occurs Irreversible
CKD
75
May progress to end-stage renal disease resulting in renal replacement therapy or transplant
CKD
76
Onset of CKD is not apparent until ___-___% of renal function is lost
50-70
77
Risk factors of CKD
Proteinuria Ethnicity Gender Smoking Heavy consumption of non-narcotic analgesics
78
Causes of CKD
Diabetes Hypertension Glomerulonephritis Hereditary congenital and cystic kidney disease Pyelonephritis Tumor
79
Symptoms of CKD
Decreased kidney function Sodium retention and edema Hypertension Metabolic acidosis K+ accumulation Microcytic anemia Renal osteodystrophy
80
A renal replacement procedure that removes toxic and excessive by-products of metabolism from the blood
Dialysis
81
Rinsing fluid that have varying ion and mineral composition
Dialysate
82
Two kinds of dialysis. Differentiate
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
Nutrition therapy goals for CKD stages 1 and 2
Focuses on the control of co-morbid conditions Slows the progression of potential CVDs Regular monitoring of biochemical indices
84
Protein recommendations for CKD Stages 3 and 4
0.60-0.75 g/kg >50% of HBV GFR <25 ml/min
85
Energy recommendations for CKD Stages 3 and 4
30-35% Low cholesterol <30% fat
86
Phosphorus recommendations for CKD Stages 3 and 4
10-12 mg/g of CHON
87
Sodium recommendations for CKD Stages 3 and 4
1-3 g
88
Calcium recommendations for CKD Stages 3 and 4
1.0-1.5 g
89
Fluid recommendations for CKD Stages 3 and 4
Maintain fluid balance
90
Vitamins and minerals recommendations for CKD Stages 3 and 4
B complex (PDRI recommendation), individualized vitamin D, Fe, Zn
91
Very common in dialysis patients
Malnutrition
92
Causes of malnutrition in CKD
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
Energy, protein, and fat recommendations for HD and PD patients
Energy: 30-35% Protein: 1.2 g/kg; 50% HBV Fat: 25-35% Cholesterol: <200 mg/day
94
Fiber recommendations for HD and PD patients
20-30 g/d
95
Potassium recommendations for HD and PD patients
HD: 2-3 g PD: ~3-4 g
96
Sodium recommendations for HD and PD patients
HD: 2-3 g PD: individualized
97
Fluid intake recommendations for HD and PD patients
HD: 1 L + urine output PD: Individualized
98
Ca recommendations for HD and PD patients
1500 mg/d
99
Phosphorus recommendations for HD and PD patients
800-1000 mg/d
100
Post transplant management is divided into two periods:
Acute - first 8 weeks Chronic - 9th week onwards
101
Nutritional goal for acute phase of post-transplant
To manage the increased metabolic needs of the surgery.
102
Nutritional goal for chronic phase of post-transplant
To include the management of co-morbidities
103
Estimated weights of ascites
Minimal - 2.2 kg Moderate - 6 kg Severe - 14 kg
104
Estimated weights of peripheral edema
Minimal - 1 kg Moderate - 5 kg Severe - 10 kg

FN 125 LE3 (5 decks)

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