nutrition- chapter 21

Question 1

nephrons

Question 2

kidneys

Answer 2

filter about 1.2 L/minute

Question 3

glomerulus

Question 4

Bowman’s capsule

Question 5

glomerular filtration rate (GFR)

Answer 5

• should be >60

Question 6

proximal tubule

Question 7

loop of Henle

Question 8

distal tubule

Question 9

collecting tubule

Question 10

excretory and regulatory functions

Answer 10

• filtration
• reabsorption
• secretion
• excretion

Question 11

endocrine functions

Answer 11

• renin secretions
• erythropoietin secretion
• vitamin D activation

Question 12

general causes of kidney disease

Answer 12

• infection and obstruction
• damage from other diseases
• genetic and congenital defects

Question 13

risk factors for kidney disease

Answer 13

• diabetes
• hypertension
• cardiovascular disease (CVD)
• age > 60
• obesity
• family history

Question 14

MNT in kidney disease

Answer 14

influenced by:
- length of disease
- degree of impaired kidney function and clinical symptoms

Question 15

acute glomerulonephritis or nephritic syndrome

Answer 15

• disease process: inflammatory process that affects glomeruli
• clinical symptoms: hematuria, proteinuria, possible edema, mild hypertension
• oliguria and anuria may develop
• MNT: diet modifications usually not crucial for acute disease

Question 16

nephrotic syndrome (nephrosis)

Answer 16

• disease process: nephron tissue damage allows protein to pass into tubule
• clinical symptom: hypoalbuminemia, edema, ascites, distended abdomen, reduced plasma protein level, eventual malnutrition
• additional symptoms may include: hyperlipidemia, lipiduria, blood clotting abnormalities, imbalances in several minerals

Question 17

MNT for nephrotic syndrome (nephrosis)

Answer 17

• protein: moderate
• energy: adequate to support nutrition status
• fats: total fat intake less than 30% total kcals/day, total cholesterol less than 200 mg/day
• sodium, potassium: sodium limited to 1-2 g/day; both closely monitored
• calcium: limited to 1 to 1.5 g/day
• phosphorus: limited to 12 mg/kg/day
• fluid: restricted in response to urine output and insensible losses

Question 18

acute kidney injury

Answer 18

disease process:
- prerenal: inadequate blood flow to kidneys and subsequent reduced GFR
- intrinsic: damage to a part of the kidney
- postrenal obstruction: obstruction of urine flow

Question 19

hematuria

Answer 19

blood in the urine

Question 20

anuria

Answer 20

failure of the kidneys to produce urine; output less than 100mL

Question 21

oliguria

Answer 21

abnormally small production of urine

Question 22

acute kidney injury

Answer 22

symptoms:
- RIFLE classification system
- acute kidney injury network (AKIN) criteria

diagnostic criteria:
- increase in serum creatinine and oliguria

• continuous renal replacement therapy (CRRT) (type of dialysis) supports kidney function for some critically ill patients

MNT:
- basic objective: improve or maintain nutrition status
- principle: appropriate intake of protein, energy, sodium, potassium, phosphorus, calcium, vitamins, minerals and fluids

Question 23

chronic kidney disease (CKD)

Answer 23

disease process:
- progressive breakdown of kidney tissue

most often results from:
- metabolic diseases with kidney involvement
- primary glomerular disease
- inherited diseases or congenital abnormality
- other causes: immune diseases, obstruction, infection, long-term use of nephrotoxic medications

Question 24

CKD

Answer 24

clinical symptoms:
- water imbalance: large amounts of dilute urine (polyuria) in early stages, followed by oliguria and finally anuria as disease progresses
- elevated blood urea nitrogen, serum creatinine, and serum uric acid levels
- electrolyte and mineral imbalance
- anemia
- hypertension

Question 25

CKD

Answer 25

general signs & symptoms:
- weakness, fatigue, and shortness of breath
- anemia
- swelling in the extremities
- itchy skin rashes
- possible anorexia, nausea, and vomiting
- protein-energy wasting (PEW) syndrome
- lower resistance to infection due to malnutrition
- Kussmaul’s breathing
- mouth ulcers, a foul taste, and bad breath
- muscular twitching and peripheral neuropathy

Question 26

MNT for CKD

Answer 26

• basic objectives: individualized treatment, adjusted to illness progression
• principles: appropriate intake of protein, energy, sodium, potassium, phosphorus, calcium, vitamins, minerals and fluids

Question 27

end-stage renal disease (ESRD)

Answer 27

disease process:
- GFR decreases to less than 15mL/min per 1.73m^2 body surface area, indicating irreversible damage to a majority of the kidneys’ nephrons

treatment options and MNT:
- hemodialysis
- peritoneal dialysis
- transplantation

Question 28

ESRD/ dialysis complications

Answer 28

long term:
- bone disorders, malnutrition, anemia, hormonal and blood pressure imbalances, depression, and diminished quality of life

additional complications:
- enteral or parenteral nutrition support
- osteodystrophy
- neuropathy

Question 29

calcium stones

Answer 29

• excess calcium in the blood (hypercalcemia) or urine (hypercalciuria)
• excess oxalate (hyperoxaluria) or uric acid in the urine (hyperuricosuria)
• low levels of citrate in the urine (hypocitraturia)

Question 30

struvite stones

Answer 30

• primarily caused by urinary tract infections

Question 31

acute on chronic kidney disease

Answer 31

• preexisting CKD
• suddenly incur AKI on top of CKD

Question 32

kidney stones

Answer 32

uric acid stones:
- impairment of purine metabolism with some diseases

other stones:
- hereditary disorders
- complications of medications

clinical symptoms:
- severe pain
- other urinary symptoms

Question 33

MNT for kidney stones

Answer 33

calcium stones:
- avoid foods that are high in oxalate; add specific types of dietary fiber

uric acid stones:
- alkaline diet; potassium citrate treatments

cystine stones
- reduce urinary cystine concentrations, reduce sodium intake, increase intake of vegetables high in organic anions, and dilute the urine with copious amounts of water

Question 34

urinary output (UOP)

Answer 34

should be at least 30mL/hr