Nutritional modulation of Renal disease Flashcards
what are the different aspects of a diet for renal disease
Food intake/Calories Protein Phosphorus Potassium Sodium Fibre Fatty acids
caloric intake
Anorexia is a big problem in CRF
diet won’t help unless palatable - good compliance
may need homemade diet if all brands rejected
Therapeutic diets dont’ be introduced when animal is hospitalised - long term plan
Consideration for feeding tubes
Appetite Stimulants
Ineffective in achieving adequate intake
Not useful during hospitalisation
Protein Restriction - Rationale
Reduction of protein attempts to minimise the generation of nitrogenous wastes, thereby “relieving” the kidney of extra workload
Controlling azotaemia may mitigate clinical signs such as anorexia, nausea, and gastritis
Possible problems with severe protein restriction
Renal repair requires a certain amount of protein
Exacerbation of malnutrition
Worsening of cachexia (wasting)
Protein restriction and Glomerulopathies
may be useful in protein losing nephropathies
Proteinuria perpetuates glomerular injury
Protein restriction reduces degree of proteinuria
May attenuate on-going injury
ACE inhibitors and fish oils may also play important roles in management
Role of Phosphorus
best nutritional intervention in renal disease revolves around phosphorus restriction
decr mortality achieved in both experimental and clinical trials
slowing progression of various forms of disease
delay clinical signs associated with renal insufficiency
Phosphorus Restriction compared to normal diet - effect
Phosphorus restricted diet - preservation of renal morphology
normal amounts of phosphorus - mineralisation, fibrosis, and infl
when to restrict phosphorus
as soon as patient becomes hyperphosphataemic - instituted early in disease
Potassium and Renal Disease
Decr in serum potassium levels common in chronic renal failure patients
Severe hypokalaemia can exacerbate renal function
May need to supplement potassium to chronic renal failure patients
Sodium and Renal Disease
Hypertension is commonly associated with renal disease
Currently no evidence sodium restriction is beneficial in animals both for hypertension and renal disease
Fibre and Renal Disease
In rodent models of renal insufficiency, addition of fermentable fibre lowers BUN (Blood urea nitrogen)
enhancement of colonic degradation of urea
incr in faecal nitrogen content
aka “nitrogen trap” in gut
Unknown if dietary fibre can reduce BUN in clinically relevant amounts
Acid-Base Status
Acidaemia common finding in advanced cases of acute renal failure
Acidosis accelerates lean body losses
Avoid urinary acidifying diets
May need alkalinising agents • Oral Na bicarbonate + Potassium citrate therapy
Omega-3 Fatty Acids
Renal disease involves a constant state of infl
Modulation of infl may modulate progression of disease
Diets rich in omega-6 fatty acids worsen renal injury in certain experimental models - Acutely incr glomerular filtration rate, Incr intraglomerular pressure, Hastened renal failure
positive effect of Omega-3 Fatty Acids
decr infl incr appetite Lowers systemic arterial pressure Alters plasma lipid concentrations Alter blood flow Lowered glomerular pressure Preserves renal function
