Renal Disease Pt. 1 Flashcards
What are some of the risk factors for renal disease?
diabetes HTN autoimmune disease UTIs Previous renal diseases History of renal diseases neoplasia age low birth weight reduction in kidney mass
What are the 3 causes of CKF?
diabetes
HTN
Other renal diseases
What are the early and later symptoms of CKF?
Early: asymptomatic
Later: fatigue, nausea, vomiting, anorexia, insomnia, itching
What are the 4 criteria for a uremic toxin to be approved?
- has to be identified
- has to be higher in uremia
- there must be symptoms associated with it
- must of been studied in vivo levels
What are the 4 CDK phases?
- decreased renal reserve
- chronic renal insufficiency
- renal failure
- ESRD
What are the 4 CKD complications?
- uremic syndrome
- anemia
- fluid imbalances
- electrolyte imbalances
What is the best way to determine how much salt a patient consumed?
24h urine collection
amount of Na x 23
What are the 4 types of treatments for CKD?
- dialysis
- transplant
- diet, meds, treatment of risk factors to preserve function
- conservative care
What are the 3 meds that are usually used to correct electrolyte imbalances?
- K supplements
- PO4 binders
- Ca supplements
What are 4 meds that are given to help with CKD?
- Antihypertensives
- EPO
- Iron supplements
- Inactive/active vit D
What is the classification of CKD?
Normal: GFR > 60 no kidney damage Stage 1: GFR > 90 with kidney damage Stage 2: 60-89 Stage 3a: 45-59 Stage 3b: 30-44 Stage 4: 15-29 Stage 5: <15
What are the two things that determine the severity of the kidney disease?
protein vs kidney function
What is the eGFR to go on predialysis?
13-50ml/min/1.73m
What are the nutrition goals for predialysis?
Low protein Restricted phosphorus Restricted potassium Restricted sodium Adequate kilocalories Healthy foods and eating habits
What is the most accurate measurements to check for protein losses?
ACR
What are 3 things to reduce the progression of diabetic nephropathy?
- optimal glycemic control
- Optimal BP control
- ACEi or ARB
What are the main food sources of potassium?
- preservatives in processed foods
- fruits and vegetables
- milk products
- nuts, seeds, legumes, lentils
- whole grains/high fiber grains
- meats
What is the most bioavailable source of phosphorus?
food additives (90-100%)
What are the main food sources of phosphorus?
- food additives
- milk/soy products
- milk alternative
- nuts and seeds
- legumes and lentils
- whole grains
What are the protein recommendations?
0.8g/kg
renal exchange = 6-8g protein
50% protein is HBV (divide total protein by two, then by 7 for the exchange)
What are the sodium recommendations?
1500-2300mg
What are some factors that complicate treatment of malnutrition?
- hyperkalemia
- fluid overload
- hyperphosphatemia
- hyperglycemia
- dyslipidemia
- past dietary restrictions
What is tolvaptan used for?
Tolvaptan is a AVP-V2 receptor blocker however patient with a high solute load (Na and protein) can produce copious amounts of urine resulting in extreme thirst
What is the low osmolar diet for and what is it?
The goal is to have a low osmolarity (280/kg) in order to suppress vasopressin
- high fluid intake
- sodium intake of 1500mg
- protein intake 0.8 g/kg
