Renal Disease - Exam 2

Question 1

What is an acute kidney injury?

Answer 1

acute decrease in kidney function as manifested by a decrease in estimated glomerular filtration rate (GFR) levels

Question 2

What happens to a person’s protein needs in an acute kidney injury?

Answer 2

need more protein intake if AKI is prolonged!
From 1.5 g/kg/day to as high as 2.5 g/kg/day (normal - 0.8 g/kg/day)

Question 3

What is chronic kidney disease?

Answer 3

The presence of persistently abnormal kidney function, as manifested by…
Decreased glomerular filtration rate (GFR) of <60 mL/min for 3+ months

Question 4

What are the top 2 causes of CKD?

Answer 4

DM and HTN

Question 5

What 2 things if well controlled can help decrease the probability of developing CKD?

Answer 5

Blood pressure

blood sugar

Question 6

_______ can also contribute to the development and progression of CKD

Answer 6

atherosclerosis

Question 7

_____ is recommended to slow down deterioration of kidney function in adult CKD patients. Why?

Answer 7

protein restriction

Reduces glomerular flow and pressures
Slows accumulation of waste products (urea, creatinine) in CKD

Question 8

**What kind of protein is recommended in CKD patients? Why?

Answer 8

plant based protein is recommended!!

**Animal-based proteins have two problematic traits:
More bioavailable phosphate for absorption
Higher potential acid load (PRAL)

Question 8

What CKD population is most at risk for nutritional deficiencies due to protein restriction?

Answer 8

pediatric CKD patients- consult dietician!!

do not resist protein in kids

Question 9

What are the protein requirements for stage 1-2?

Answer 9

(GFR >60) - no need for outright restriction
recommended intake 0.8g/kg/day
encourage plant based proteins

Question 10

What are the protein requirements for stages 3-5 of CKD?

Answer 10

GFR < 60
protein restriction to help slow CKD progression
More aggressive restriction as CKD gets worse - 0.6-0.8 g/kg/d
Higher proportion of plant-based proteins as CKD gets worse

Question 11

What are the protein requirements for a CKD pt who is stage 5 and on dialysis? Hemodialysis vs peritoneal dialysis?

Answer 11

actually require increased protein intake from previous diet plans, especially on days they are receiving dialysis

Hemodialysis - 1.0 - 1.2 g/kg/day, Peritoneal Dialysis - up to 1.3 g/kg/day

Question 12

The ____ diet is recommended for pt with CKD. What are the general guidelines?

Answer 12

Plant-Dominant Low Protein Diet (PLADO)

Protein Intake - 0.6-0.8 g/kg/day

Protein Sources - >50% of protein from plant sources: Tofu, chickpeas, nuts, mushrooms, beans, lentils, legumes, quinoa

B12 supplementation may be needed due to lower meat intake

Sodium - restricted to < 4 g/day
<3 g/day if HTN or edema

Fiber - high fiber intake (>25 g/day)

Caloric Intake - adequate (30-35 cal/kg/day)

Question 13

What are 2 potential challenges of a low protein diet?

Answer 13

high glycemic index

high potassium load leading to hyperkalemia

Question 14

What are the guidelines for a very low protein diet with supplementation?

Answer 14

Protein Intake - 0.28-0.43 g/kg/day (about 1/3 of the normal amount of protein)

Protein Sources - encourage protein from plant sources

B12 and/or iron supplementation may be needed

Special Supplements - amino acids, keto acids, hydroxy acids

Greatly reduces nitrogenous waste load by reducing amount of amino groups
Less nitrogenous waste → less hyperfiltration in the kidney → less CKD progression

Sodium - restricted to < 3-4 g/day

Fiber - high fiber intake (>25 g/day)

Caloric Intake - adequate (30-35 cal/kg/day)

Question 15

What special supplements are needed in a very low protein diet? Why?

Answer 15

amino acids, keto acids, hydroxy acids

Greatly reduces nitrogenous waste load by reducing amount of amino groups

Question 16

CKD patients, especially later-stage, are vulnerable to malnutrition!
May develop overt ____ and ____

Answer 16

wasting

cachexia

Question 17

What are the big 3 that can cause kidney disease?

Answer 17

DM
HTN
heart disease

Question 18

What is the fat recommendation?

Answer 18

Limit saturated fats, trans fats

Promote intake of polyunsaturated and monounsaturated fats, especially omega-3

Question 19

What is the effect of fiber on a CKD pt? **What is the recommended intake?

Answer 19

Promotes fecal nitrogen excretion

Lowers the amount of waste products that have to be dealt with by kidney

Decreases serum urea (BUN) and creatinine levels

lowers inflammation levels in the body

**25-30 grams/day

Question 20

What is the recommended salt intake for a pt with CKD?

Answer 20

Similar levels to general population limits - < 3-4 g/day

or if more severe CKD: < 2300 mg/d often recommended)

Question 21

**What is the recommended fluid intake for an average CKD pt? What about if there are complications?

Answer 21

About 1.5 L/day for average patients

1.0 L/day or less if complications

Question 22

What is important to know about CKD and potassium?

Answer 22

diseased kidneys tend to lose ability to excrete potassium especially later stage 4-5

consider potassium restriction of less than 3 grams/day in the later stage of CKD

Question 23

What are some pt education points to offer to those later stage CKD pts who need to monitor potassium intake?

Answer 23

Offer patients a list of high and low potassium foods
Boiling fruits/vegetables - reduces potassium by 50-70%
Regular serum potassium checks
Medications to reduce potassium if neede

Question 24

CKD patients often lose ability to manage ______. What does it lead to ?

Answer 24

acid-base balance

metabolic acidosis secondary to impaired renal function

Question 25

_____ contribution of food or dietary pattern to net endogenous acid (H+) production. Give some examples of food high and low

Answer 25

Potential Renal Acid Load (PRAL)

high PRAL: Hard cheeses and egg yolks (animal-based foods)

low PRAL: Raisins and spinach (plant-based foods)

Question 26

What are 2 ways to reduce acid levels in a pt with CKD?

Answer 26

sodium bicarbonate or 2-4 cups of fruits/veg per day

Question 27

CKD pts also have a hard time excreting _______. Give an example of food that should be avoided. Why?

Answer 27

phosphorus

dark sodas, processed foods as a preservative

inorganic phosphorus is 90% absorbed vs organic phosphorus is only 30-60% absorbed

Question 28

What is the recommendation with regards to stage 3-5 CKD and phosphorus?

Answer 28

800 mg/day (more restricted as more severe)

Encourage organic phosphorus in fruits/vegetables to meet dietary needs

Question 29

What is the recommendation for Vit D/calcium and CKD? Why? What will happen to the calcium levels as vit D is replaced?

Answer 29

Vitamin D supplement is generally indicated in all stages of CKD

CKD → less circulating active vitamin D → less calcium absorption in the GI tract

Calcium levels will generally increase when vitamin D is replaced

Question 30

CKD pts are also at risk of ______ and ______. What is the solution?

Answer 30

water-soluble vit def (Bs and Cs)

iron

give kidney-friendly multivitamin +/- iron supplementation

Question 31

Why is iron low sometimes in CKD pts?

Answer 31

Decreased absorption due to hepcidin, less heme-based iron in CKD diet

Question 32

In CKD pts _____ supplementation may help with lipid levels

Answer 32

Carnitine

Question 33

___ and ____ are often deficient in CKD pts on dialysis. Need to avoid _____ based medications

Answer 33

zinc/selenium

aluminum