Renal Flashcards
1
Q
How much blood does the kidney filter?
A
1600 L/day
2
Q
What is the functional unit of the kidney?
A
nephrons
3
Q
What does the nephron consist of?
A
glomerulus connected to tubules
4
Q
What are the three different parts of a tubule?
A
- proximal convoluted tubule
- loop of henle
- collecting duct
5
Q
What are the four functions of the kidney?
A
- filtration
- absorption
- excretion
- secretion
6
Q
how much glucose and water do the kidneys absorb?
A
- glucose 100%
- water 85%
7
Q
What do the kidneys absorb?
A
- glucose
- amino acids
- water
- sodium
- potassium
- chloride
8
Q
What do the kidneys excrete?
A
- wastes
- urea
- excess ketones
9
Q
The kidneys secrete hormones that control __________________ and _____________
A
blood pressure, blood components
10
Q
What do ions that the kidney secrete do?
A
maintain acid-base balance
11
Q
What does vasopressin do?
A
- exerts pressor effect, elevates blood pressure
- increases water reabsorption from distal and collecting tubules
12
Q
what is renin secreted by and when is secreted?
A
glomerulus, when blood volume decreases
13
Q
What does renin do?
A
stimulate aldosterone to increase sodium absorption and return blood pressure to normal
14
Q
what is erythropoietin secreted by and what does it do?
A
kidney, stimulate bone marrow to produce RBC`
15
Q
What are the S/S of renal disease?
A
- anemia due to decreased production of EPO
- upset in blood pressure
- decrease activation of vitamin D
- oliguria
- azotemia
16
Q
When investigating kidney stones …what should a diet history evaluate?
A
- intake of fluids
- protein (types and amounts)
- calcium
- sodium
- high oxalate foods
- fruits
- veggies
- medications and supplements
17
Q
What is the % frequency of calcium oxalate or calcium phosphate stones?
A
70-80%
18
Q
What is the % frequency of uric acid kidney stones?
A
10-15%
19
Q
What is the % frequency of magnesium ammonian phosphate stones?
A
10-15%
20
Q
What is the cause of calcium oxalate or calcium phosphate stones?
A
- low urine volume
- high urinary excretion of Ca
- hyperuricosuria
- hyperoxaluria
- low urine citrate
21
Q
What is the cause of uric acid kidney stones?
A
- low urine volume and pH
- metabolic acidosis
- hyperuricosuria
- obesity
- metabolic syndrome
22
Q
What is the cause of magnesium ammonium phosphate?
A
-struvite, infection-related (urea-splitting bacteria)
23
Q
What are the general recommendations for kidney stones?
A
- at least 3 L fluid/day needed
- adequate calcium intake (1000-1200 mg/day)
- reduce calcium urine load
- reduce sodium intake to 1500 mg/day
- reduce oxalate`
24
Q
how do you reduce oxalate?
A
- adequate calcium intake to bind oxalate
- eat fewer high-oxalate foods
25
What are high oxalate foods?
- spinach
- nuts
- beets
- rhubarb
- French fries
- potato chips
- all-bran
26
To prevent acidic stones....
- create alkaline ash
- increase cations by adding veggies, milk, and fruits
- reduce meats, fish, etc.
27
What is nephrosis?
Defect in capillary basement membrane of glomerulus which permits escape of large amounts of protein into the filtrate moving through the tubules.
28
What are the symptoms of neprhosis?
- albuminurea
- low serum albumin
- edema
- hyperlipidemia
29
what is the tx treatment for nephrosis?
- protein .8-1 g/kg
- maintain good nutritional status
- reduce sodium to 1.5-2 g/day
- medications to reduce blood cholesterol, statins
30
What is the GFR range and description of stage 1 CKD?
90-130 ml/min
| kidney damage, but normal to increased kidney function
31
What is the GFR range and description of stage 2 CKD?
60-89 ml/min
| mild decrease in kidney function
32
What is the GFR range and description of stage 3 CKD?
30-59 ml/min
| moderate decrease in kidney function
33
What is the GFR range and description of stage 4 CKD?
15-29 ml/min
| severe decrease in kidney function
34
What is the GFR range and description of stage 5 CKD?
less than 15 ml/min
| kidney failure with treatment, defined as end stage renal disease
35
What are the symptoms of CKD?
- anorexia
- weakness
- weight loss
- nausea
- vomiting
36
What is anorexia due to in CKD?
deficient production of EPO by kidney
37
What are the needs of stage 1, 2, and 3 for CKD?
based on energy expenditure and needs
38
What are the calorie needs for stage 4?
25-35 kcals based on SBW or adjusted BW
39
What are the needs for stage 4?
.8 g/kg, 50% HBV
less the 2 g salt per day
20-30 g fiber
phosphorus 800-1000
40
what are the causes of acute renal failure?
-trauma, medication and/or infection
41
What are the causes of chronic renal failure?
- diabetes
- HTN
- trauma
- infection
- polycystic kidney disease
- obstructions
- congenital defects
- glomerulophritis
42
What does renal disease do to GFR and creatinine clearance?
both decrease
43
What does renal disease do to serum creatinine and BUN?
both increased
44
What is a renal solute load?
solutes excreted in 1 L urine
45
what does the renal solute load measure?
nitrogen and sodium
46
what is the daily fixed solute load?
600 mOsm
47
What are the S/S of ESRD?
- uremia
- malaise
- weakness
- N/V
- neurological impairment (from retention of nitrogenous wastes)
48
What are nutrition goals for ESRD?
- increase calories
- control edema
- prevent deficiencies and toxicities
49
What are the calorie needs for stage five?
30-35 >60 years
| 35 under 60 years, SBW and ABW
50
What are the protein needs for a stage five CKD , weight stable?
1.2
| at least 50% HBW
51
What are the protein needs for a stage five CKD , acutely ill or PEM?
1.2-1.3
| at least 50% HBV
52
What are the sodium goals for CKD 5?
750-2000 mg Na+
53
What are the potassium goals for CKD 5?
70-80 mEq/day, adjust for serum levels
54
what are the fiber goals for CKD 5?
20-25 g/day
55
What are the fluid goals for CKD 5?
750-1500 ml/day
56
What are the phosphorus goals for CKD 5?
10-17 mg/kg/day
57
What are the calorie goals for CKD 5 peritoneal dialysis?
under 60 yrs, 35 kcals/kg
| over 60 yrs, 30-35 kcals/kg
58
What are the protein needs for CKD 5 for PD?
1.2-1.3 g/kg
59
What are the sodium goals for CKD 5 for PD?
2000
60
What are the potassium goals for CKD 5 for PD?
3-4 grams
61
What are the fiber goals for CKD for PD?
20-25 g/day
62
what are the fluid goals for CKD for PD?
unrestricted
63
What are calcium goals for CKD for PD?
800 mg
64
What are the iron goals for CKD for PD?
10-15 mg/day
65
What are the phosphorus goals for CKD for PD?
800 mg
66
What is ABW formula?
edema free weight+ [ (standard bw-edema free bw) x .25]
67
What is the goal for Albumin in patients that are on HD?
Albumin >4
68
What is the goal for calcium in patients that are on HD?
8.5-10.5 mg/dL
69
What is the goal for phosphorus in patients that are on HD?
3-4.5 mg/dL
70
What is the goal for phosphorus in patients that are on HD?
3.5-5.5
71
What is the goal for kt/v in patients that are on HD?
>1.2
72
What is the goal for URR in patients that are on HD?
>65%
73
What is the goal for Hemoglobin that are on HD?
12-18
74
What is the goal for PTH that are on HD?
150-600
75
What is the goal for CaXPo4 in patients that are on HD?
76
what is the goal for A1C that are on HD?
77
What are the 16 fruits that are high in potassium?
1. apricot 2. avocado 3. banana
4. cantaloupe 5. dates 6. dried fruits
7. grapefruit juice 8. honeydew
9. kiwi 10. mango 11. nectarine
12. orange/juice 13. papaya
14. pomegranate 15. prunes/juice 16. raisins
78
What are the 26 vegetables that are high in potassium?
1. acorn squash 2. artichoke 3. bamboo shoots 4. baked beans 5. butternut squash
6. refried beans 7. beets 8. black beans
9. broccoli 10. Brussel sprouts 11. Chinese cabbage 12. carrots 13. dried beans and pea
14. greens, except kale 15. hubbard squash
16. kohlrabi 17. legumes 18. lentils
19. mushrooms 20. parsnips 21. potatoes
22. pumpkin 23. rutabaga 24. spinach
25. tomatoes 26. vegetable juices
79
What are the other 12 foods that are high in potassium?
1. bran
2. chocolate
3. granola
4. milk
5. molasses
6. nutritional supplements
7. nuts and seeds
8. peanut butter
9. salt substitutes
10. salt-free broth
11. chewing tobacco
12. yogurt
80
What are the seven high phosphorus beverages?
1. ale
2. chocolate drinks
3. drinks made with milk
4. canned iced teas
5. beer
6. cocoa
7. dark colas
81
What are eight high phosphorus dairy products?
1. cheese
2. custard
3. milk
4. cream soups
5. cottage cheese
6. ice cream
7. pudding
8. yogurt
82
What are eight high phosphorus protein foods?
1. carp
2. beef liver
3. fish roe
4. oysters
5. crayfish
6. chicken liver
7. organ meats
8. sardines
83
What are twelve high phosphorus vegetables?
1. dried beans and peas
2. baked beans
3. chick peas
4. kidney beans
5. limas
6. pork n' beans
7. soy beans
8. black beans
9. garbanzo beans
10. lentils
11. northern beans
12. split peas
84
What are the seven other foods that are high phosphorus foods?
1. bran cereals
2. caramels
3. seeds
4. whole-grain
5. brewer's yeast
6. nuts
7. wheat germ
