Renal: CKD and pre-dialysis Flashcards
Uremic toxins: def (4)
1) Identified substance
2) [higher] in uremia
3) symptoms associated
4) studied at in vivo levels.
the three causes of chronic renal failure
DM, HTN, other renal disease
T/F Urea is a confirmed toxins
T
T/F leptin is a confirmed toxins
F suspected
T/F creatinine is a confirmed toxins
F suspected
4 phases of CKD
- decrease renal reserve
- chronic renal insufficiency
- Frank renal failure
- End stage renal disease
chronic renal insufficiency
GFR decreases to 30 ml/min
Waste products begin to accumulate.
CRI can be mild, moderate, or severe.
Frank renal failure
creatinine and BUN rise steadily due to drop in GFR.
End stage renal disease
` uremia
• < 15% of normal function (for pt with DM) ; < 10% (no DM)
• All body systems are impaired
• Dialysis and/or transplant is needed to prevent complications and death
• Symptoms are generally the main consideration when initiating dialysis (fatigue, poor appetite, fluid overload and electrolyte abnormalities)
T/F Typical symptoms is one key indication to diagnose chronic liver diseases.
F
not all patients have symptoms, but if there is any, there must be some disease.
Most time, ppl screen CKD through GFR level in Chem 7 test, and diagnosis throught testing proteinuria.
Uremia
high level of urea in the blood
CKD: Complications (4) and causes
Uremic syndrome (high urea and creatinine in blood) Anemia (decreased erythropoietin) Fluid imbalances (Na imbalance, edema) Electrolyte imbalances (high K, acidity, PO4)
common lab tests: 7
- Creatinine and creatinine clearance rate
- BUN: blood urea nitrogen
- Electrolytes
- Iron status measurements
- 24 hr urine collection
- PTH?
- Renal biopsy or u/s: to differenciate the types of CKD…not helpful from NUTR side
why check iron status
my lose during dialysis or blood test
24 hr urine collection to test:
if protein or sodium in the urine
why do 24 hr unrine sodium collection
- For number of sodium
- Test for patient’s compliance
- The Na intake dosage
- Even for the individuals have a salty meal, it should take days to eliminate.
- Tell them drink enough as well
- Tell them drink enough as well
4 Treatments of CKD
- Dialysis
- Transplant: less than 15% function (the end stage)
- RD focus: Diet, medication and treatment of risk factors to preserve kidney function (HTN, DM, CVD)
- Side focus–quality of life, at the end stage: Conservative care
The indication of each CKD stage 1
normal or increased? GFR (≥ 90 mL/min per 1.73 m2) with kidney damage†
The indication of each CKD stage 2
mildly decreased GFR (60–89 mL/min per 1.73 m2) with kidney damage
The indication of each CKD stage 3a
mild to moderately decreased GFR (45–59 mL/min per 1.73 m2)
The indication of each CKD stage 3b
mild to moderately decreased GFR (45–59 mL/min per 1.73 m2)
The indication of each CKD stage 4
severely decreased GFR (15–29 mL/min per 1.73 m2)
The indication of each CKD stage 5
kidney failure (GFR < 15 mL/min per 1.73 m2)
4 general goals for nutrition intervention during pre-dialysis
• Delay the progression of CRF
- achieving ideal body weight (maximise the calories)
• Preventing or alleviating the symptoms of uremia and restoring biochemical balance
• Maintaining/improving quality of life