Nutrition

Question 1

Is dietary management of kidney disease always indicated?

Answer 1

No

Not always immediately required - depends on type and stage of disease

Question 2

Can nutrition alleviate some clinical signs associated with azotaemia?

Answer 2

Yes

Question 3

Can diets modulate the progression of renal disease?

Answer 3

Yes

Question 4

What are the typical features of a kidney diet?

Answer 4

High fat

low protein

Question 5

What should you consider when trying to initiate kidney diets?

Answer 5

Type of renal Dz
Stage of renal disease
Nutritional status - growing, geriatric, what BCS 
Concurrent diseases 
Practical considerations

Question 6

What concurrent diseases should be considered when initiating a KD?

Answer 6

Cardiac dz

Obesity

Question 7

What are nutritional aspects which need to be managed in kidney disease?

Answer 7

Food intake / calories - a lot of CKD patients inappetant
Protein
Phosphorous
Potassium
Sodium
Fibre - get Nitrogen without the body needing to
Fatty acids - can manipulate type

Question 8

When should a hospitalised patient be put on a renal diet?

Answer 8

AT HOME

transition gradually

Question 9

What could improve the appetite of CKD patients?

Answer 9

Omega-3 fatty acids

May also help conserve lean body mass

Question 10

What problems are associated with severe dietary protein restriction

Answer 10

Renal repair requires protein

Exacerbation of malnutrition cachexia due to breakdown of muscle protein

Question 11

When should protein restriction be initiated?

Answer 11

When there are clinical signs associated with azotaemia

Question 12

What IRIS stages indicate nutritional intervention in dogs?

Answer 12

Stage 1 WITH proteinuria - therapeutic diet and ACE inhibitor

Stage 2- consider diet

Stage 3 - feed diet

Question 13

What IRIS stages indicate nutritional intervention in cats?

Answer 13

Stage 2- consider
Stage 3- feed
— will have hyperphosphataemia

Question 14

Which species requires more protein?

Why?

Answer 14

Cats

Always burning protein even when they’re not eating
Dogs slow protein metabolism when they’re not eating

Question 15

What should the dietary approach to proteinuria be?

Answer 15

Reduction but not too much - select slightly lower protein food

ACE inhibitors to restore charge on glomerulus

Fish oils to reduce inflammation

Question 16

How can you avoid secondary nutritional hyperparathyroidism ?

Answer 16

RESTRICT PHOSPHOROUS

Question 17

When is phosphate reduction indicated?

Answer 17

As soon as the patient becomes hyperphosphataemic

-EARLY

Question 18

What happens to potassium levels in chronic renal failure?

Answer 18

Hypo

Question 19

What acid base changes are anticipate in acute renal failure?

How can this be assisted with diet?

Answer 19

Acidaemia

Avoid acidifying diets

Question 20

What are the benefits associate with omega-3 FAs?

Answer 20

Reduced inflammation
Lower systemic arterial pressure 
Alters plasma lipid concentrations
Alter blood flow 
Lowered glomerular pressure 
May improve appetite 
Preserves renal function