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POS 2 > Nutrition In Renal Dz > Flashcards

Nutrition In Renal Dz Flashcards

1
Q

Can special diets prevent renal disease?

A

No

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2
Q

Can you alleviate ureamic signs related to kidney disease?

A

Yes

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3
Q

Can you slow progression of renal disease?

A

Yes

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4
Q

Nutritional aspects of managing renal disease?

A
  • protein
  • calories
  • phosphorus
  • potassium
  • nsodium
  • fibre (bacteria ferment and also take up ammonia and urea)
  • fatty acids
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5
Q

When should diet be changed with renal disease?

A

After they have been fixed in hospital and gone home - long term benefits don’t need to be implemented straight away

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6
Q

When may appetite stimulants be useful?

A
  • not during hospitalisation

- once at home

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7
Q

What are the benefits of omega 3 fatty acids?

A
  • potential appetite stimulant

- lots of benefits

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8
Q

How can adequate intake be ensured when animal is inappetant

A
  • feeding tube

- discuss quality of life if d/t chronic kidney failure

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9
Q

Rational for protein restriction

A
  • minimise nitrogenous waste
  • control azotaemia (anorexia, V+, gastritis etc)
    > problem
  • if implemented too early renal repair is problematic
  • exacerbation of malnutrition and cackexia (catabolic state)
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10
Q

What level of azotaemia warrants protein restriction?

A
  • not clearly defined
  • common recommendation BUN >27g/l
  • if chance diet early more likely to eat the diet
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11
Q

Typical protein levels in maintainance diet. What is protein restriction

A

Dogs

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12
Q

Other than CKD when may protein restriction be useful?

A

> glomerulopathy

  • protein losing nephropathy
  • proteinuria perpetuates glomerular injury
  • dont over restrict
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13
Q

Other than protein restriction what can help in protein losing nephropathies?

A

ACE inhibitors and fish oil

- help restore charge to membrane in kidney

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14
Q

Does protein restriction help renal patients?

A
  • can alleviate some uraemia signs

- high protein diets do not cause renal damage!!!

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15
Q

When is phosphorus restriction commended?

A
  • as soon as hyperohosphataemia early in dz
  • may also need phosphorus binders with food
  • content usually parallels protein levels
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16
Q

Does potassium go up or down with CKD?

A
  • up

- CKD pateints need potassium restricted (evidence for v mort rates and prevention of 2* renal hyperparathyroidism)

17
Q

How can renal acidosis be treated?

A 
Sodium bicarbonate (though cats not likely to eat this) 
- prescription diet
18
Q

How is sodium implicated in renal disease in animals?

A
  • not the same as man w.r.t. Sodium chloride

- currently no evidence that NaCl restriction helps animals

19
Q

How does fibre affect renal disease?

A
  • lowers BUn in rodents

- enhanced colonic degradation of urea and ammonia (^ resident bacteria to ferment fibre)

20
Q

How is acid base status affected by kidney disease?

A
  • acidaemia common in advanced acute kidney failure
  • acidaemia causes catabolic state (ubiquitin-proteosome system)
  • protein breakdown requires energy and worsens negative energy state
  • metabolic acidosis enhances progression of renal failure by promoting renal amoniagenesis and activating alternate complement pathway -> renal injury
21
Q

Which fatty acids are good for you?

A

Omega 3

Omega 6 usual fat source, worse for you

22
Q

Why are omega 3 fatty acids helpful in kidney disease?

A

Renal disease causes constant state of inflammation
- arachadonic acid pathway breaking down cell membrane -> inflammatory signals
- if omega 6 incorporated into cell membrane instead then when it is broken down the inflammatory mediators are less potent
> ratios used to be thought to be important, not thought anymore
> not know if all forms of kidney disease benefit

23
Q

Positive effects of omega 3 FAs?

A
  • v inflam
  • lowers systemic arterial pressure
  • alters plasma lipid concentration
  • alters blood flow
  • lowered glomerular pressure
  • improves appetite??
  • preserves renal function
24
Q

Supplementation recommendations for omega 3 FAs?

A

EPA 40mg/kg/d
DHA 25mg/kg/d
> concentrated fish oil supplements (for medical doses)
1 capsule per 4.5kg body weight

25
Q

Can you reverse BUN levels in chronic kidney failure?

A

Unlikely

26
Q

Does renal disease always require diet change?

A

No - spectrum of disease

27
Q

How is caloric intake associated with renal disease? How can this be addressed?

A
  • inapetant d/t kidney dz -> malnourishment
  • do not try and change food immediately
  • just get them to eat anything you can
  • ## IV fluids and gastroprotectants

POS 2 (28 decks)

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