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Advanced MNT 1 > Renal Disease Part 2 > Flashcards

Renal Disease Part 2 Flashcards

1
Q

Chronic Kidney disease is also called ______

A

chronic renal failure (CRF)

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2
Q

Chronic kidney disease is defines as either ______ or ____________

A

kidney damage or GFR <60 ml/min/1.73m2 for ≥ 3 months

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3
Q

chronic kidney disease is a _______ in kidney function over time

If detected early, medication and dietary changes may ______

A

gradual decline
slow the progression

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4
Q

what is the best measure of kidney function

A

GFR

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5
Q

GFR is used to categorize a patient regarding the _____ of chronic kidney disease

A

stage

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6
Q

GFR is calculated by MD using the patient’s serum ________ level, age, race, body size, and gender

A

creatine (Cr)

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7
Q

expert in kidney disease

A

nephrologist

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8
Q

Stage one description and GFR

A

possible kidney damage with normal GFR

≥90

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9
Q

stage two description with GFR

A

kidney damage with mild decrease in GFR

60-89

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10
Q

stage three description and GFR

A

moderate decrease in GFR (problems occur)

15-29

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11
Q

stage four description and GFR

A

severe decrease in GFR (make plan for dialysis or transplant)

15-29

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12
Q

stage 5 description and GFR

A

kidney failure, end stage renal disease (ESRD)

<15 or on dialysis

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13
Q

oliguria ?

A

inadequate urine output

100 - <500 ml/d of urine output

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14
Q

anuria ?

A

complete cessation of urine flow

0 - <100 ml/d of urine output

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15
Q

Some causes of Chronic Kidney Disease
- _______
- _______
- glomerulonephritis
- polycystic kidney disease
- systematic lupus erythematous (SLE)
- repeated UTIs
- nephrotic syndrome

A

DM
HTN

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16
Q

signs and symptoms of CKD

A

azotemia
uremia

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17
Q

the accumulation of abnormal quantities of nitrogenous wastes in the blood

what are these wastes?

A

azotemia

BUN

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18
Q

physical signs and symptoms related to azotemia

A

uremia

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19
Q

uremia symptoms

A

malaise (tired)
weakness
N/V
muscle cramps
pruritus (itching)
dysgeusia
neurological impairment

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20
Q

normal glomerular filtration rate (GFR)

A

90-120 ml/min/1.73 m2

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21
Q

in CKD, serum _____ levels and ______ levels can INCREASE

A

creatine

BUN

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22
Q

normal creatine

A

0.5-1.1 mg/dL for women
0.6 - 1.2 mg/dL for men

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23
Q

daily production of creatine depends on ______

A

muscle mass

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24
Q

Medical Treatment for CKD

A

treat/manage underlying causes
Dialysis
transplantation

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25
Q

types of dyalisis

A

hemodialysis (more common in US)

peritoneal dialysis

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26
Q

Hemodialysis (HD) removes ____ and _____ from the body

usually requires ___ sessions a week for ____ hours each

A

waste
excess fluid

3
3-5

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27
Q

In Hemodialysis, ______ passes through a _______ membrane to be filtered

  • _____ products are removed thru _____
  • water removal is called __________ and is done with pumps that are connected to the dialysis machine
A

blood
semipermeable

waste
diffusion

Ultrafiltration

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28
Q

a collection of thousands of hollow plastic fibers inside a plastic cylinder

A

dialyzer

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29
Q

types of vascular access

A

fistula
graft
catheter

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30
Q

Arteriovenous (AV) fistula is made by ?

How?

A

sewing together an artery and a vein in the forearm to make the vein stronger and larger

2 needles inserted into the fistula (one for withdrawing bool and one for returning blood)

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31
Q

why get a arteriovenous fistula

A

to make a vein that is strong and large enough for routine dialysis

takes a couple months for it to be ready to use

32
Q

preferred/reccomended access for long term HD

Why

A

AV fistula

less prone to infections and blood clots

veins and arteries self-heal after each needle stick, so fistulas can last a long time

33
Q

Arteriovenous Graft is a ?

A

piece of tubing that is used to surgically attach an artery and a vein

34
Q

arteriovenous graft is more likely to have difficulty with _____ because it is made out of synthetic material.

develop _____ because the material cannot _____ after needle punctures

A

blood clots

holes
self-heal

35
Q

most common HD access ?

why?

A

arteriovenous graft

ready a couple weeks after placements

36
Q

catheters would be placed in the ____ or ____ and inserted into a _______ vein

A

neck or chest
central

37
Q

catheters used for ?

A

short term temporary time sensitive access

38
Q

advantage of catheter

disadvantage of catheters

A

can be used the same day

most prone to infection
can be accidentally pulled out

39
Q

advantages of HD compared to peritoneal

A

patient involvement is minimal
treatment is controlled by trained staff

40
Q

disadvantages of HD

A

time consuming
loss of protein (up to 15g per treatment)
fluctuations in serum levels of urea, K, Phos, and Fluid

41
Q

complications of hemodialysis

A

hypotension
infections at access site
graft failure

42
Q

what is peritoneal dialysis (PD)

A

Dialysis that uses the semipermeable membrane of the peritoneum as the dialyzer

43
Q

PD works by infusing _____ into the ______ through a surgically placed catheter in order to create a concentration gradient.

waste products and electrolytes pass from the ______ through the peritoneal membrane into the _______ via ______

water passes via _____

dialysate is then drained form the peritoneal cavity

A

high dextrose dialysate
peritoneal cavity

blood
dialysate
diffusion

osmosis

44
Q

PD Dialysate bags hold ___, ____, and ___ liters of solution

the strength can vary from ___, ____, or _____ percent

A

1.5
2.0
2.5

1.5%
2.5%
4.25% (if large amount of water needs removed)

45
Q

Types of PD

  1. _______ AKA ________
  2. ________________
A

Automated Peritoneal Dialysis (APD)
continuous cyclic peritoneal dialysis (CCPD)

Continuous Ambulatory Peritoneal Dialysis (CAPD)

46
Q

Automated Peritoneal Dialysis (APD)
aka - continuous cyclic peritoneal dialysis (CCPD)

Uses a _________ for installation &
drainage of the dialysis solution

usually done _____

A

machine (cycler)

overnight

47
Q

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Performed using __________

A

gravity-based technology

48
Q

Steps for Performing CAPD

A
  1. Fill: Dialysate enters the peritoneal cavity (bag hung)
  2. While fluid dwells in the peritoneal cavity, extra fluid
    and wastes are drawn out of the blood and into the
    dialysis fluid.
  3. Drain: After ~4-6 hours the dialysis fluid is drained-called and replaced by fresh fluid.
49
Q

Advantages of PD

Dialysis is done _____
__________ in serum levels of urea, K+, & fluid
________ treatment
More ______ diet
May contribute to a more ______ lifestyle (especially if using ____)

A

daily
Less fluctuations
Home-based
liberal
flexible
APD

50
Q

Disadvantages of PD

Protein losses of_____ g/day

_______ can be absorbed from the dialysate and contribute on average ______ kcal/day
Weight _____

Poorly controlled ____
Complication=> ________

A

20-30

Dextrose
400-800
gain

DM
peritonitis

51
Q

Evaluating the Adequacy of Dialysis

Studies have shown that patients who are not adequately dialyzed have an increased risk of _____________

A

morbidity & mortality

52
Q

Complications of CKD

Alterations in fluid volume=>________
Electrolyte abnormalities: ________
_____
Metabolic _______
Secondary _____________
Glucose _________

A

hypervolemia
Na, K+, & Phos
HTN
acidosis
hyperparathyroidism
intolerance

53
Q

Measurement of reduction of urea that occurs during a dialysis treatment is __________

To calculate: _____________

Well-dialyzed if there is a reduction in urea by >_____

A

Urea Reduction Ratio (URR)

(predialysis BUN – postdialysis BUN) / predialysis BUN

65%

54
Q

Anemia from CKD
__________________ anemia

caused by:

Inability to produce __________

Increased ___________ due to circulating ___________

A

Normochromic, normocytic

erythropoietin

destruction of RBCs
uremic waste products

55
Q

Signs/symptoms of CKD anemia:

Decreased serum _________

____________________

A

Hgb & Hct

Fatigue, pallor, lightheadedness, SOB

56
Q

IV iron can come in different forms… including _______, ________, and _______.

A

iron dextran (Infed)
iron gluconate (Ferrlecit)
Iron Sucrose (Venofer)

57
Q

goal is to have serum ferritin be ______ ng/mL but _____ ng/mL for HD patients receiving EPO

A

> 300

<800

58
Q

Human Recombinant Erythropoietin=> Epogen (EPO) has a food drug interaction that ___________

Solution?

A

increases need for iron for production of RBC

IV iron
iron stores measured monthly (look at serum ferritin)

59
Q

Renal Osteodystrophy signs and symptoms

A

Bone pain
pathologic fractures (break under little stress)
metastatic calcifications

60
Q

Renal Osteodystrophy
Pathophysiology=> As renal function declines:

Kidneys cannot excrete ____ load=> _______

Serum ____ levels decline due to:

Decrease in ______=> decreases intestinal absorption of ___

A

Phos
hyperphosphatemia

calcium
1,25 dihydroxyvitamin D3
Ca

61
Q

Renal Osteodystrophy

Low serum Ca levels trigger release of ____________ leading to ____________

Increase in calcium phosphorus product=> leads to ____________

A

Parathyroid Hormone (PTH)
bone resorption of Ca

calcifications of soft tissues

62
Q

____________________ = calcifications

National Kidney Foundation (NKF) goal: _______

A

serum Ca x serum Phos > 70 mg2/dL2

Keep Ca x Phos product < 55 mg2/dL2

63
Q

MNT for Renal Osteodystrophy

For the calcium, adjust total intake from _____, ________, & ________ to avoid ________

______ supplements (__________)
_________ supplementation (_______)

A

food
supplements
Ca-based Phos binders
hypercalcemia

Calcium (Calcium carbonate)
Active vitamin D (Rocaltrol)

64
Q

Calcium supplements should be given ___________ (when?)

A

on an empty stomach
between meals
at bedtime

65
Q

MNT for Renal Osteodystrophy

For the Phosphorus=>______________

_____________ medications:
MOA=> bind phos in the gut
Calcium-containing binders
Calcium Acetate (PhosLo), Calcium Carbonate (Oscal)

Complication=> hypercalcemia
Sevelamer hydrochloride (Renagel)=> lowers Phos
without increasing Ca
Ferric citrate=> iron-based binder
Take phosphate binders with meals

A

Decrease dietary phosphorus intake to <1000 mg/d

Phosphate-binding

66
Q

Phosphate-binding medication contain _____________ and _____________

A

MOA which binds phos in the gut

Calcium-containing binders

67
Q

calcium containing binders include

A

calcium acetate (PhosLo)
calcium carbonate (Oscal)
Sevelamer hydrochloride (Renagel)

68
Q

Complication with calcium containing binders

A

hypercalcemia

69
Q

Sevelamer hydrochloride (Renagel) does ?

Example of iron based binder ?

Take phosphate binders at what time?

A

lowers phos without increasing Ca

Ferric citrate

with meals

70
Q

High prevalence of _____ in patients on long-term dialysis secondary to ____

Also caused by Accelerated __________

A

CVD
HTN

atherosclerosis

71
Q

Non-traditional risk factors for CKD CVD:

___________
____________
____________

MNT: ________________

A

inflammation & oxidative stress
abnormalities of lipoprotein metabolism
vascular calcifications

Mediterranean diet pattern may improve
lipid profiles

72
Q

Other Complications of CKD
Increased ____________ tendency

Impaired ________ function=> Increased susceptibility to infections

A

bleeding
leukocyte

73
Q

Neurologic manifestations of CKD CVD=>

A

insomnia
difficulty concentrating
peripheral neuropathy
restless leg syndrome
seizures
encephalopathy

74
Q

MNT for CVD CKD

A

Mediterranean diet pattern to improve lipid profiles

75
Q

One of the most common complications of CKD –
especially for those on dialysis

A

Malnutrition

76
Q

Factors Leading to ______
N/V
Taste alterations
Anorexia
Fatigue
Multiple dietary restrictions
Inadequate intake due to depression, missed meals due to dialysis, food insecurity, inability to obtain or prepare food

A

Malnutrition

77
Q

Factors Leading to Malnutrition

__________ interactions
___________ from dialysis treatments
Inflammatory response=> __________ requirements

A

Food-drug
Protein loss
increases protein

Advanced MNT 1 (20 decks)

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