Renal Disease

Question 1

What are some of the functions of the kidneys?

Answer 1

• excretion of waste
• homeostasis of fluid and electrolytes
• homeostasis of blood pressure (renin-angiotensin system, ADH)
• acid base balance
• Production of hormones
  (erythropoietin and renin)
• Vit D activation

Question 2

What is glomerular filtration rate (GFR)?

What is the normal range?

What is the disease range?

Answer 2

Fluid (100 ml/min) is filtered by the kidneys.

The rate at which fluid is eliminated is known as Glomerular filtration rate (GFR).

GFR is the best indicator of kidney function.

Normal GFR = 100 or > 90

Disease = < 60
Kidney failure = < 15

Question 3

What is chronic kidney disease?

• describe the different stages

Answer 3

Long‐term condition that describes abnormal kidney function and/or structure, or a GFR of <60ml/min/1.73m2 present on at least two occasions that are 90 days apart.

• also based on ACR (albumin:creatinine ratio) in urine.

Stage 1
- kidney damage with normal GFR

Stage 2
- kidney damage with small decrease in GFR

Stage 3
- moderate decrease in GFR

Stage 4
- severe decrease in GFR

Stage 5
- kidney failure

Question 4

What are the risk factors for CKD?

Answer 4

• Diabetes (diabetic nephropathy)
• High blood pressure
• Obesity
• Nephrotic syndrome
• Heart failure

Question 5

What are the consequences of CKD?

Answer 5

• Fluid and sodium retention
• Hypertension
• Dyslipidaemia
• CVD (also main cause of death)
• High serum K levels (hyperkalaemia)
• Mineral and bone disorders
• Anaemia
• Protein and energy wasting

Question 6

Describe recommendations for nutritional assessment of CKD
(ABCDEF)

Answer 6

A
- Body weight (dry weight)
- Weight change
- Skinfold callipers may be used (MUAC, TST)

B
- Urea
- Creatinine
- eGFR
- Potassium
- Phosphate
- Serum albumin
- CRP
- PTH
- Urinary protein loss and fluid status
- Serum cholesterol

C
- appetite
- oedema
- co-morbidities

D
- protein and energy intake (24-hr recall , 3-day diet diary)
- foods high in Na, PO, K?

F
- HGS

Question 7

What is the dietetic management of CKD 1-3?

Answer 7

• Healthy BMI(weight management)
• Protein should not be <0.8g/kg/day
• Salt <6g/d
• Normal fluid intake unless fluid retention
• Normal K intake unless hyperkalaemia
• Normal P intake (no evidence to support low-phosphate diet)

Question 8

What is the dietetic management of CKD 4?

Answer 8

• Maintain a healthy well-balanced diet
• Energy intake 35 Kcal/Kg/d; 30 Kcal/Kg/d for those >60 years
• Monitoring of fluid serum electrolytes levels (severity depends on each patient)
• No added salt advice: 5-6 g
• Low K diet if necessary
• Low P diet (hyperphostaemia is common at this stage)
• If oedema, restrict fluid intake to 500-750 ml in addition to daily urine output
• Protein intake of 0.8g/kg of IBW/day

Question 9

What is some low K diet advice?

Answer 9

REDUCE INTAKE OF:

Fruits
- banana
- avocado
- dried fruit

Vegetables:
- spinach
- mushroom
- beetroot
- tomato

Potato - chips, baked potato, crisps

Nuts and seeds - soya products

Coffee and malted drinks

Limit milk - 1/2 pint/day

FOOD PREPARATION

• cut veg into small pieces
• after boiling throw water away

Question 10

What is some low PO diet advice?

Answer 10

REDUCE INTAKE OF:

Meat:
- liver
- ham
(Phosphorus found in animal foods is absorbed more easily than phosphorus found in plant foods)

Fish:
- most shellfish
- sardines
- monkfish

Beans:
- kidney beans
- soya beans
- haricot (baked) beans

Cheese spread/processed cheese

Drinks:
- dark fizzy drinks
- bovril
- malted drinks

Question 11

What are the nutritional recommendations for patients on HD?

Answer 11

• Nutritional supplement (ONS)
• Protein ≥ 1.1 – 1.2 g/Kg IBW
• Energy 30-35 Kcal/Kg/d
• Fluid (500-1000 ml in addition to daily urine output)
• Low K diet
• Low Na diet
• Low P diet

Weight management

Consequences of immunosuppression treatments
(obesity, dyslipidaemia, diabetes, hypertension, mineral and bone disorders)