Renal: CKD and pre-dialysis

Question 1

Uremic toxins: def (4)

Answer 1

1) Identified substance
2) [higher] in uremia
3) symptoms associated
4) studied at in vivo levels.

Question 2

the three causes of chronic renal failure

Answer 2

DM, HTN, other renal disease

Question 3

T/F Urea is a confirmed toxins

Answer 3

T

Question 4

T/F leptin is a confirmed toxins

Answer 4

F suspected

Question 5

T/F creatinine is a confirmed toxins

Answer 5

F suspected

Question 6

4 phases of CKD

Answer 6

1. decrease renal reserve
2. chronic renal insufficiency
3. Frank renal failure
4. End stage renal disease

Question 7

chronic renal insufficiency

Answer 7

GFR decreases to 30 ml/min
Waste products begin to accumulate.
CRI can be mild, moderate, or severe.

Question 8

Frank renal failure

Answer 8

creatinine and BUN rise steadily due to drop in GFR.

Question 9

End stage renal disease

Answer 9

` 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)

Question 10

T/F Typical symptoms is one key indication to diagnose chronic liver diseases.

Answer 10

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.

Question 11

Uremia

Answer 11

high level of urea in the blood

Question 12

CKD: Complications (4) and causes

Answer 12

Uremic syndrome (high urea and creatinine in blood)
Anemia (decreased erythropoietin)
Fluid imbalances (Na imbalance, edema)
Electrolyte imbalances (high K, acidity, PO4)

Question 13

common lab tests: 7

Answer 13

1. Creatinine and creatinine clearance rate
2. BUN: blood urea nitrogen
3. Electrolytes
4. Iron status measurements
5. 24 hr urine collection
6. PTH?
7. Renal biopsy or u/s: to differenciate the types of CKD…not helpful from NUTR side

Question 14

why check iron status

Answer 14

my lose during dialysis or blood test

Question 15

24 hr urine collection to test:

Answer 15

if protein or sodium in the urine

Question 16

why do 24 hr unrine sodium collection

Answer 16

• 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

Question 17

4 Treatments of CKD

Answer 17

1. Dialysis
2. Transplant: less than 15% function (the end stage)
3. RD focus: Diet, medication and treatment of risk factors to preserve kidney function (HTN, DM, CVD)
4. Side focus–quality of life, at the end stage: Conservative care

Question 18

The indication of each CKD stage 1

Answer 18

normal or increased? GFR (≥ 90 mL/min per 1.73 m2) with kidney damage†

Question 19

The indication of each CKD stage 2

Answer 19

mildly decreased GFR (60–89 mL/min per 1.73 m2) with kidney damage

Question 20

The indication of each CKD stage 3a

Answer 20

mild to moderately decreased GFR (45–59 mL/min per 1.73 m2)

Question 21

The indication of each CKD stage 3b

Answer 21

mild to moderately decreased GFR (45–59 mL/min per 1.73 m2)

Question 22

The indication of each CKD stage 4

Answer 22

severely decreased GFR (15–29 mL/min per 1.73 m2)

Question 23

The indication of each CKD stage 5

Answer 23

kidney failure (GFR < 15 mL/min per 1.73 m2)

Question 24

4 general goals for nutrition intervention during pre-dialysis

Answer 24

• 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