nutrition- chapter 21 Flashcards
nephrons
kidneys
filter about 1.2 L/minute
glomerulus
Bowman’s capsule
glomerular filtration rate (GFR)
- should be >60
proximal tubule
loop of Henle
distal tubule
collecting tubule
excretory and regulatory functions
- filtration
- reabsorption
- secretion
- excretion
endocrine functions
- renin secretions
- erythropoietin secretion
- vitamin D activation
general causes of kidney disease
- infection and obstruction
- damage from other diseases
- genetic and congenital defects
risk factors for kidney disease
- diabetes
- hypertension
- cardiovascular disease (CVD)
- age > 60
- obesity
- family history
MNT in kidney disease
influenced by:
- length of disease
- degree of impaired kidney function and clinical symptoms
acute glomerulonephritis or nephritic syndrome
- 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
nephrotic syndrome (nephrosis)
- 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
MNT for nephrotic syndrome (nephrosis)
- 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
acute kidney injury
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
hematuria
blood in the urine
anuria
failure of the kidneys to produce urine; output less than 100mL
oliguria
abnormally small production of urine
acute kidney injury
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
chronic kidney disease (CKD)
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
CKD
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
