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Clinical Nutrition 3 > Renal Diseases > Flashcards

Renal Diseases Flashcards

1
Q

What is nephrotic syndrome?

A

A condition marked by (1) the deficiency of albumin in the blood and (2) protein excretion in the urine due to altered permeability of the basement membranes

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2
Q

When protein is lost in the urine, what does this lead to?

A

-Puffiness or swelling (edema), often of the eyelids, feet and ankles and eventually the abdomen

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3
Q

If left untreated, what can nephrotic syndrome lead to?

A

Problems with breathing, eating and infections

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4
Q

Criteria for nephrotic syndrome?

A
  • Urinary protein levels >3.5 grams per day

- Average loss of 6-8 g/dat

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5
Q

Causes of nephrotic syndrome?

A
  • Usually unknown
  • May be diabetes
  • It is a primary glomerular disease
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6
Q

Symptoms and complication of nephrotic syndrome?

A
  • Proteinuria
  • Hypoalbuminemia
  • Edema,weight gain
  • Hyperlipidemia
  • Sodium retention
  • Hypocalcemia
  • Low iron
  • Loss of appetite
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7
Q

What may be elevated in nephrotic syndrome due to decreased clearance?

A

Pre-albumin

Recall that pre-albumin is high in CKD

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8
Q

What can impair renal function?

A

Elevated lipid levels, where there is elevated T-Chol, TG and LDL-C in nephrotic syndrome

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9
Q

Is HDL affected in nephrotic syndrome?

A

Reduced or unaffected

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10
Q

Why is there hyperlipidemia in nephrotic syndrome?

A

Due to increased lipid synthesis and decreased catabolism

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11
Q

What does the level of hyperlipidemia correlate with?

A

The extent of proteinuria

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12
Q

Complications with nephrotic syndrome?

A
  • High total cholesterol and TG
  • Malnutrition
  • High BP
  • AkI
  • CKD
  • Infections
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13
Q

What are the key nutritional goals in nephrotic syndrome?

A

1) Reduce proteinuria
2) Prevent negative N balance
3) Control hyperlipidemia
4) Minimize edema
5) Delay further progression of renal disease and atherosclerosis

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14
Q

Energy?

A

35 kcal/kg/day

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15
Q

Protein?

A

0.8-1.0 g/kg/day

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16
Q

Sodium?

A

1-2g/kg/day

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17
Q

Calcium?

A

1-1.5 g/kg

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18
Q

Fluid?

A

1-1.5L/day

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19
Q

What is nephrolithiasis?

A

Kidney stones or renal lithiasis

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20
Q

When does nephrolithiasis occur?

A

When calcium, oxalate, struvite, cystine, hydroxyapatite or uric acid in the urine are higher than normal amounts

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21
Q

Risk factors for nephrolithiasis?

A
  • family hx
  • Previous stone formation
  • **Hypercalciuria (most frequent)
  • Hyperoxaluria
  • Low urine volume
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22
Q

Other causes of kidney stones?

A

-Gout, excessive intake of vitamin D, UIT, urinary tract blockages and low urine output

23
Q

What is the normal 24 hr urinary calcium excretion in men?

A

> 300 mg/24 hr

24
Q

What is the normal 24 hr urinary calcium excretion in women?

A

> 250 mg/24 hr

25
Q

Pathophysiology of kidney stones?

A

Imbalance between solubility and precipitation of mineral salts within the urine

26
Q

What are the factors that contribute to stone development?

A
  • Abnormal urine flow, urine composition, and presence of renal calculi that cause retention of urine
  • Hydration status, as it is linked to the volume of urine produces
  • Urine pH
27
Q

How can kidney stones be based?

A
  • Most can pass with lots of fluids and pain meds

- Some may require a medical procedure

28
Q

Medical procedure for kidney stones?

A

Extracorporeal Shock Wave lithotripsy is most common

29
Q

What should we focus on in our nutritional assessment?

A

The factors which are related to the stone development

30
Q

What is our nutritional diagnosis likely to be?

A

-Excessive mineral intake, inadequate fluid intake, or food and nutrition related knowledge deficit

31
Q

Nutritional therapy for kidney stones?

A
  • Increase fluid intake by 3L/day, divided into doses
  • No need to avoid dairy (calcium)
  • Avoid >200 mg/day of vitamin C
  • Use of probiotics
32
Q

Why should vitamin C be limited?

A

When we eliminate vitamin C through the urine, the vitamin C will become oxalate, which will compound this issue with crystal formation

33
Q

Why should we use probiotics?

A

They will facilitate the breakdown of oxalate

34
Q

Why is limiting calcium not recommended?

A

As it can be many minerals which will create the stones - we can evaluate where the crystals came from after the stone was passed - in the case that it was calcium and then the patient had another kidney stone, then maybe we would limit calcium

35
Q

Which diets correlate with more acidic urine and increase risk of stone formation?

A

Diets higher in intake of animal proteins and low intakes of fruits and vegetables
->DASH diet has been shown to reduce kidney stones

36
Q

Low urine output (<2L/day) MNT nutrition goal?

A

Promote ample and dilute urine output to prevent urine supersaturation

37
Q

MNT strategies for Low urine volume?

A

-Increase fluid intake (>3L/day) and distribute throughout the day

38
Q

Hypercalciuria (>250 mg/day) MNT nutrition goal?

A
  • Promote renal calcium absorption
  • Normalize bone retention if sub-optimal
  • Normalize GI absorption if excessive
39
Q

MNT strategies for Hypercalciuria and promoting renal calcium absorption?

A
  • Reduce potential renal acid load
  • Reduce NaCl and sodium
  • Reduce refined CHOS
40
Q

MNT strategies for normalizing bone retention and normalizing GI absorption?

A

Increase dietary fiber

41
Q

Hyperoxaluria (>45 mg/day) MNT nutrition goal?

A
  • Enhance GI binding potential for oxalate
  • Reduce oxalate biosynthesis
  • Normalize (reduce) oxalate absorption
  • Enhance bacterial degradation potential
42
Q

How can we enhance GI binding potential for oxalate?

A
  • Increase calcium and magnesium intake with meals

- Reduce intake of high oxalate foods if dietary intake is high

43
Q

How can we reduce oxalate biosynthesis?

A
  • Try pyridoxine if enzyme dysregulation is suspected

- D/c ascorbic acid supplements if >200 mg/day

44
Q

How can we reduce oxalate absorption?

A

Address fat malabsorption if it is a contributing factor

45
Q

How can we enhance bacterial degradation potential?

A
  • Initiate probiotic therapy

- Increase dietary prebiotics

46
Q

Hyperuricosuria (>700 mg/day) MNT nutrition goals?

A
  • Reduce uric acid biosynthesis

- Reduce uric acid precipitation load

47
Q

How can we reduce uric acid biosynthesis?

A

-Decrease meat high in purines

48
Q

Hypernatriuria (>200 mmol/day) MNT nutrition golas?

A
  • Minimize calciuric effect of extra-cellular volume expansion
  • Minimize efficacy of diuretic therapy
49
Q

How can we treat hypernatriuria?

A

-Decrease NaCl and sodium intake to lowest levels possible

50
Q

Low urine pH (<5.6) MNT nutrition goal?

A

Reduce crystallization potential for uric acid and cystein calciul

51
Q

Strategies to combat low urine pH?

A
  • Reduce potential acid renal load
  • Address bicarb wasting
  • Address obesity, diabetes
52
Q

Examples of high oxalate foods?

A
  • Beets
  • Spinach
  • Rhubarb
  • Nuts
  • Chocolate
  • Dried beans
53
Q

To reduce oxalate absorption, increase ____ and limit ___

A
  • Calcium

- Vitamin C

54
Q

The use of probiotics is to increase the _____ of oxalate in the GI tract

A

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Clinical Nutrition 3 (30 decks)

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