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Advanced MNT 1 > Renal Disease > Flashcards

Renal Disease Flashcards

1
Q

Functional unit of the kidney - the “filter”

A

Nephrons

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2
Q

____________ nephrons per kidney

Nephron Consists of the ________ and series of
_______

A

1.25 million

glomerulus
tubules

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3
Q

Glomerulus is a Spherical mass of _________
Function=>produces ________

A

capillaries
ultrafiltrate

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4
Q

Ultrafiltrate- fluid produced after filtering the
blood through the _______ into _______

Contains water, Na, K+, ____, ______, & ______
_______-free

A

glomerulus
Bowman’s capsule

urea
creatinine
glucose

Protein

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5
Q

Renal Tubules
- Selectively reabsorb substances from the_____ and secrete substances into the _____

A

ultrafiltrate
urine

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6
Q

Proximal tubule

Reabsorption of _______________

Secretion of ____

A

Na
K+
amino acids
glucose
bicarbonate
phosphorus
Ca
ure
water

H+

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7
Q

Loop of Henle

__________ of ultrafiltrate
Reabsorption of _________

A

Concentration
water & sodium

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8
Q

Distal tubule

Reabsorption of ____________

Secretion of ___________

A

Na
water
bicarbonate

K+
urea
H+
ammonia
some drugs

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9
Q

Collecting duct

Reabsorption of _____

Reabsorption or secretion of _____________

A

water

Na, K+, H+
ammonia

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10
Q

Fluid leaving the ________=>urine

Urine enters the ________=> narrows to _______ per kidney, which carries urine into the bladder

Urine accumulates and is then eliminated via the ______

A

collecting duct

renal pelvis
1 ureter

urethra

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11
Q

Antidiuretic hormone (ADH )

Secreted by the ________ in response to a ________ in total body ____ indicated by an _________

Makes ________________ ______ permeable to H2O

_______ water reabsorption=> ______ urine volume

A

pituitary
decrease
H2O
increased serum osmolality

distal tubule & collecting duct
more

Increase
decreases

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12
Q

Aldosterone

Secreted from the ________ in response to a ___________

________ reabsorption of ____ in the distal tubule & collecting duct

_______ water reabsorption=> _________ urine volume

A

adrenal cortex
decrease in blood pressure/blood volume

Increases
Na

Increases
decreases

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13
Q

Function of the Kidney

  1. _______
  2. _________
  3. _________
A

Excretory
Maintain homeostasis
Endocrine

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14
Q

Excretory function of kidney includes
Waste products such as ______________

A

urea
creatinine
organic acids

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15
Q

Maintenance of homeostasis includes balancing ________, ________, and _______.

A

Sodium & water balance
Electrolyte balance
Acid-base balance

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16
Q

Endocrine function of kidney includes
_______________

A

Renin
Erythropoietin
Vitamin D/calcitriol

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17
Q

Renin is an enzyme produced in the__________ of the kidney in response to __________ or _________

Renin Reacts with _________ in the blood to form ________, which is a _________ and stimulates the release of ________

A

juxtaglomerular
apparatus
decreased blood pressure
decreased serum sodium

angiotensin I
angiotensin II
vasoconstrictor
aldosterone

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18
Q

Hormones Produced by the Kidney

A

Erythropoietin

Vitamin D3/calcitriol

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19
Q

Erythropoietin acts on _________ to stimulate the production of _____

A

stem cells of the bone marrow
RBC

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20
Q

Vitamin D3/calcitriol is the final site of _________

Increases ____ absorption in the gut

A

vitamin D activation
Ca

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21
Q

A type of urinary tract infection (UTI) that
affects one or both kidneys

A

pyelonephritis

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22
Q

symptoms of pyelonephritis

A

painful urination and hematuria

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23
Q

____________ in ______________ seem to inhibit the adherence of _______ to the epithelial cells of the urinary tract

A

Tannins & flavanols
cranberries & blueberries
E-coli bacteria

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24
Q

Concentration of components of urine reaches
levels where crystallization occurs

A

nephrolithiasis

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25
Q

can get kidney stones from _____ also

A

gout

26
Q

stones could be composed of ?

A

Ca salts

Uric acid

Struvite (composed of magnesium ammonium phosphate and carbonate apatite)

Cystine

27
Q

if uric acid, diet should be

A

low in animal protein

28
Q

Risk Factors for the Development of Kidney Stones

volume of urine? ______
Family history
gender? _____
___________
__________
________=>increased excretion of Ca, oxalate, & uric acid

A

low
Male
Hypercalciuria
Hyperoxaluria
Obesity

29
Q

Kidney Stones

Most migrate down the urinary tract and pass out of the body without medical intervention

Can become lodged in the ______, obstruct
urine flow and cause acute pain

A

urinary tract

30
Q

MNT for Nephrolithiasis

A

Prevention: >2.5 L fluid/day to produce increased amounts of dilute urine

Individualize dietary treatment based on composition of kidney stones

Weight management

31
Q

Most common type of stone is ______
60% of stones are _________
10% ___________
10% ______________________

A

calcium
calcium oxalate
calcium phosphate
calcium oxalate & calciumphosphate

32
Q

Hypercalciuria may be due to:

_______ hypercalciuria
primary or general ___________
excess _________ intake
____________ use
renal ______________

The relationship between calcium intake and the risk
of calcium stone formation is complex

A

Idiopathic
hyperparathyroidism
vitamin D
glucocorticoid
tubular acidosis

33
Q

MNT for calcium stones

Adequate Ca intake
Consume the DRI from food: ______ if age <50
years and ______ if age >50 years

Divide intake between __________

Avoid ______________ unless needed
- associated with increased risk of stone formation

If supplements are needed, take ______
Reduce _____ intake

A

1000 mg
1200 mg

> 3 eating sessions
calcium supplements

with meals
sodium

34
Q

Calcium Oxalate Stones

Hyperoxaluria is caused by…

High dietary _____ intake
_______________=> unabsorbed fat binds to calcium=> less calcium available to bind oxalates=>________ absorption of
oxalates

______ disorders
_________ supplements

A

oxalate
Fat malabsorption
increased

Genetic
Vitamin C

35
Q

MNT for Calcium Oxalate Stones
Avoid high-oxalate foods such as?

____________________________________________
high doses of the
_____________
Consume with ____________ food to reduce oxalate absorption

A

rhubarb
spinach
strawberries
chocolate
wheat bran and whole-grain wheat products
nuts (almonds, peanuts, or pecans)
beets
tea (green or black)

spice turmeric
calcium-rich

36
Q

Kidney disorder characterized by the loss of the
glomerular barrier to protein

A

Nephrotic Syndrome

37
Q

clinical manifestations of nephrotic syndrome

A

Hypoalbuminemia (from low albuminemia)
Edema
High blood pressure (from not peeing out enough)
Hypercholesterolemia

38
Q

nephrotic syndrome can be caused by

amyloidosis, & glomerulonephritis
Can be acute or chronic and progress to CKD

A

DM, systemic lupus erythematosus

39
Q

MNT for Nephrotic Syndrome

Dietary protein level remains controversial __________ pro/kg IBW

This level is believed to decrease renal damage without reducing _________

High calorie to spare protein: ____ kcal/kg
IBW

________ Na restriction Low SFA diet

A

0.8-1.0 g
level 20
2 grams

40
Q

Acute Kidney Injury (AKI) AKA acute renal failure (ARF)
Characterized by a sudden __________
Accumulation of __________ in the blood
Duration:________________

A

decrease in the glomerular filtration rate (GFR)
nitrogenous wastes
few days to several weeks

41
Q

CAUSES of acute kidney injury

A

prerenal
intrinsic
postrenal

42
Q

prerenal phase

__________ kidneys
Occurs with _____________________

A

Hypoperfused kidneys
Occurs with dehydration, hypovolemia, hypotension

43
Q

Intrinsic

Diseases within the _____________
__________________ is the most common cause

may develop from use of ___________, _______, or _______

A

renal parenchyma
Acute tubular necrosis (ATN)

nephrotoxic drugs or dyes
trauma
septicemia

44
Q

Postrenal

___________ from various conditions including

____________
____________
____________
_____________

A

Obstruction in urine flow

Bladder & prostate cancer
Nephrolithiasis
Urethral occlusion
BPH (benign prostatic hypertrophy)

45
Q

Progression of AKI Phases include ?

A

Oliguric phase
Diuretic phase
Recovery phase

46
Q

Oliguric phase of AKI

Significant __________ in ___________
Urine output <_____ mL/d
Increased serum ___________

A

reduction
glomerular filtration rate (GFR)

500

BUN, Cr, K+, Phos, Mg

47
Q

Diuretic phase of AKI

Increased _______
______% normal

Increased risk of ________

A

urine output
150-200

dehydration

48
Q

Recovery phase of AKI

Renal function ________
Generally, occurs ______ after the injury is corrected

A

normalizes
2-3 weeks

49
Q

Clinical Manifestations of AKI

_______________=> leads to ______

___________

__________

A

Azotemia: buildup of nitrogenous waste products in the blood
uremia

Metabolic acidosis

Hyperkalemia

50
Q

Uremia is a clinical syndrome caused by _____________

A

high levels of nitrogenous waste products (e.g., urea, uric acid, & ammonia) in the blood

51
Q

Uremia Syndrome includes:

A

Malaise
Weakness
N/V
Muscle cramps
Pruritus
Dysgeusia
Neurological impairment

52
Q

Goals for AKI Medical Treatment

Goals:
Control _______________
Improve __________________

A

accumulation of uremic toxins
fluid & electrolyte imbalances

53
Q

AKI Treatment:
Correct _________
May require ___________ or ___________

A

underlying causes
intermittent hemodialysis (IHD)
Continuous Renal Replacement Therapy (CRRT)

54
Q

Medical Treatment for AKI
Continuous Renal Replacement Therapy (CRRT)
Used for _________

common form of CRRT _________________

A

critically ill patients

CVVHD - continuous venovenous hemodialysis

55
Q

CVVHD - continuous venovenous hemodialysis

Removes ____________
________ is an issue
Can have ______% absorption of _______ from ______

A

water, electrolytes, & waste products

Protein loss

35-45%
dextrose from dialysate

56
Q

Nutritional Issues in AKI

_________ state=> Loss of ______

________ serum K+, Phos, & Mg due to:
__________ renal clearance
_________ muscle catabolism

Nutritional requirements are affected by:
_____________
______________

A

Hypercatabolic, LBM

Increased
Decreased
Increased

Degree of hypercatabolism
Type of renal replacement therapy (if any)

57
Q

MNT for AKI

Energy: ____________

Protein:_______ g/kg IBW for noncatabolic patients, not on
dialysis
__________ g/kg IBW if increased protein is needed based on cause of AKI, but patient is not on dialysis

_________ g/kg IBW or UBW for intermittent hemodialysis (IHD)
_______ g/kg IBW or UBW for CRRT or are hypercatabolic

A

25-40 kcal/kg IBW

0.8-1.0
1.0-1.2
1.0-1.5
1.5-2.5

58
Q

Fluid Needs

If anuric and not on CRRT=> ___________ L/d
Diuretic phase=>_____________
Restriction usually not necessary on CRRT

A

restrict to 1-1.2
replace output + 500 ml

59
Q

MNT in AKI - Electrolytes
Need to monitor serum values closely

Sodium:
Restrict to _______ g/d in _____ phase
Replace losses in _______ phase

Potassium:
Restrict to ________mEq/d in _________
Replace losses in _______ phase

__________: Limit as necessary

A

1.1-3.3
oliguric
diuretic

30-50
oliguric phase
diuretic

Phosphorus

60
Q
A

Advanced MNT 1 (20 decks)

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