RENAL

Question 1

what are some functions of the kidney

Answer 1

• filter blood
• remove metabolic waste
• maintain fluid balance
• balance electrolytes
• maintain acid-base balance (pH)
• red blood cell production
• control blood pressure
• vit D activation

Question 2

what happens when you have chronic kidney disease

Answer 2

• unable to remove excess fluid, metabolic waste
• high phosphate levels
• poor appetite but increased requirements if on dialysis

Question 3

how many stages of CKD and what stages would you start dialysis?

Answer 3

stage 1-5
- start dialysis ~ stage 4

Question 4

how is GFR related to kidney function

Answer 4

GFR tells you how much kidney function you have
- GFR goes down as kidney function goes down

Question 5

what is the GFR range

Answer 5

• 90 or higher to less than 15

Question 6

describe peritoneal dialysis

Answer 6

blood is cleaned using the abdomen
- blood is cleaned inside your body using lining of the stomach that acts as a filter
- through diffusion - extra fluid and waste is left out
- can be done at home
- catheter is inserted to get the acid out

Question 7

describe hemodialysis

Answer 7

blood flows out and the waste get filtered out with excess fluid
- cleaning happens inside the dialyser
- treatment is 2-6 hours, 3 times a week

Question 8

what are the main nutrition considerations in CKD?

Answer 8

• potassium
• phosphate
• sodium
• fluids
• kcal/protein/vitamins and minerals

Question 9

nutrition requirements for CKD Diet (stage 3-5, GFR <60) - protein, fluid, electrolytes

Answer 9

protein: limited protein
fluid: no fluid restriction
electrolytes: sodium <2300mg/d and potassium/phosphorus per labs

Question 10

nutrition requirements for hemodialysis Diet (stage 3-5, GFR <60) - protein, fluid, electrolytes

Answer 10

protein: high protein
fluid: 1L + urine output
electrolytes: sodium <2300mg/d, potassium and phosphorus per labs

Question 11

nutrition requirements for peritoneal Diet (stage 3-5, GFR <60) - protein, fluid, electrolytes

Answer 11

protein: high protein
fluid: drink to thirst, typically no restriction
electrolytes: sodium <2300mg/d, potassium and phosphorus per labs

Question 12

what is the main difference between acute kidney injury and chronic kidney injury

Answer 12

acute - potential to recover, is irreversible
- onset is different: chronic is a progressive loss, acute is quick onset

Question 13

how to calculate weight if on dialysis?

Answer 13

use dry weight - post dialysis weight

Question 14

what labs to look at for CKD

Answer 14

pH regulation: GFR, HCO2, BUN, creatinine
- electrolytes: Na, K, P, Mg, Ca
- Hct, Hgb - kidneys stimulate red blood cells (anemia)
- alb, pre-alb - markers of inflammation
- vit D

Question 15

what is acute kidney injury

Answer 15

abrupt cessation or decline in GFR that results in failure to maintain fluid, electrolyte, and acid-base balance
- associated with many clinical situations that result in a stress- or injury- induced hypercatabolic state

Question 16

what are some risk factors of AKI

Answer 16

• age > 75
• CKD
• cardiac failure
• liver disease
• diabetes
• nephrotoxic medication use
• sepsis

Question 17

what is prerenal AKI

Answer 17

• impaired blood flow to kidneys
• causes: hypovolemia (low extracellular fluid secondary to combing sodium and water loss) due to hemorrhage, burns, diarrhea, vomiting, inadequate fluid replacement

Question 18

what is intrinsic AKI?

Answer 18

• damage within kidney cells
• causes: exposure to toxins such as antibiotics, chemotherapy, or contrast dyes

Question 19

what is postrenal (obstructive) AKI?

Answer 19

• obstruction in urine flow (urinary tract obstruction)
• causes: bladder cancer, benign prostate hyperplasia, kidney stones

Question 20

what are some clinical manifestations of AKI?

Answer 20

• low urine output
• fluid and electrolyte disorders
• azotemia - waste products in blood are too high
• wasting

Question 21

treatment of AKI?

Answer 21

treat the underlining cause
- electrolyte imbalances: IV replacement + meds
- fluid imbalances: diuretics + dialysis

Question 22

main interventions for AKI

Answer 22

• optimize nutrition status
• minimize uremia (urine in blood)
• preserve body protein stores until renal function returns
• maintain fluid, electrolyte, and acid-base homeostasis

Question 23

energy, protein, fluid, and electrolyte interventions for AKI

Answer 23

energy: meet requirements and minimize lean body mass breakdown

protein: DO NOT RESTRICT PROTEIN

fluid: depends on degree of residual renal function (generally utput + 400-500mL)

electrolytes: based on labs

Question 24

what is nephrolithiasis

Answer 24

kidney stones - crystallization of calcium, oxalate, struvite, cystine, hydroxyapatite or uric acid that is not excreted normally in the urine

Question 25

factors contributing to the stone development:

Answer 25

• abnormal urine flow
• urine composition
• presence of renal calculi
• hydration status
• pH of the urine

Question 26

risk factors of kidney stones:

Answer 26

• LOW URINE VOLUME
• family history
• previous stone formation
• medical conditions
• gout
• excess intake of vitamin D

Question 27

diagnosis and treatment of kidney stones:

Answer 27

• most can pass with plenty of fluid and pain meds
• medical procedures if unable to pass

Question 28

intervention of kidney stones:

Answer 28

goal: minimize the super-saturatio of urinary components associated with the formation of stones and to prevent stones from recurring
- increase fluid intake by 3L/d in divided doses
- ensure minimum urine output of 2L/d
- DASH diet - lowest risk for development (more fruits and vegetables and less animal proteins)
- avoid > 200mg Vitamin C a day