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Clinical Nutrition 3 > Renal Intro > Flashcards

Renal Intro Flashcards

1
Q

3 main functions of kidneys?

A
  • Maintain homeostasis
  • Excretion of metabolic end products
  • Production of enzymes and hormones
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2
Q

Maintain homeostasis?

A
  • Control of fluid (water)
  • pH
  • Electrolyte balance
  • Blood pressure
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3
Q

Excretion of metabolic end products?

A
  • Uric acid, creatinine, urea, drugs
  • Urea and excess water from blood excreted into the urine
  • *Most important function**
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4
Q

Production of enzymes and hormones?

A
  • Renin (BP)
  • EPO (RBC synthesis)
  • 1,25-dihydroxycholecalciferol (Calcitriol)
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5
Q

What is glomerular filtration?

A

Non-discriminent filtration of a protein free plasma from the glomerulus into the Bowmans capsule

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6
Q

What is tubular reabsorption?

A

Selective movement of substances from the tubular lumen into the peritubular cavities

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7
Q

What is tubular secretion?

A

Selective movement of non-filtered substances from the peritubular capillaires into the tubular lumen

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8
Q

What do the walls of the glomerulus allow for?

A

Free flow of water soluble materials into the bowmans capsule

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9
Q

The pressure in the glomerulus is ____ higher than other capillaries

A

3-4 x higher

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10
Q

Which arteriole is narrower?

A

Efferent

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11
Q

What does glomerular filtration discriminate on?

A

Size and charge

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12
Q

What is a normal GFR?

A

120 ml/min or 105-135 ml/min

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13
Q

What substances are normally filtered?

A

-Water, electrolytes, glucose, nitrogenous wastes such as urea and creatinine

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14
Q

Which substances are normally excluded from filtration?

A
  • Substances >79 kDA

- Plasma protein bound to substances

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15
Q

How can we evaluate kidney function via lab tests?

A
  • Microalbuminuria
  • GFR
  • Tubular function tests
  • Morphological evaluation (Microscopic, radiologic, biopsy)
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16
Q

What is the GFR

A

The expression of the quantity of glomerular filtrate formed each minute, in the nephrons of both kidneys, calculated my measuring the clearance of specific substances (inulin or creatinine)

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17
Q

What may influence creatinine measurement? (Serum)

A
  • Antibiotics inhibit secretion
  • Tubular secretion overestimates GFR by 10%
  • Filtration decreased with age
  • Muscle breakdown and diet
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18
Q

When using the MDMR, Which population is GFR decreased?

A

Females

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19
Q

When using the MDMR, Which population is GFR increased?

A

Black ethnicity

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20
Q

When is CKD-EPI more accurate than MDRD for estimating GFR?

A

When GFR >60

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21
Q

When is CKD-EPI just as accurate as MDRD for estimating GFR?

A

When GFR <60

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22
Q

3 ways to estimate GFR?

A

1) Crock-fold and Gaut
2) MDRDPreferred
3) CKD-EPI

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23
Q

When will CKD-EPI overestimate eGFR?

A

In patients with low BMI

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24
Q

When will CKD-EPI underestimate eGFR?

A

In patients with muscular hypertrophy

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25
Q

How does the CKD-EPI equation work to estimate eGF?

A

By estimating creatinine clearance

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26
Q

What does the CKD-EPI adjust for?

A

Age and gender and ethnicity

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27
Q

Which equation does not adjust for weight?Why?

A

MDRD

-As the final number is based on 1.73 m^2 of body surface area, which is an accepted average adult surface area

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28
Q

What does the MDRD adjust for?

A

Age, gender and ethnicity

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29
Q

AKI and ARF?

A

Acute Kidney Injury/ Acute Renal failure

30
Q

Stages of AKI/ARF?

A

-Prerenal, Postrenal, Intrarenal

31
Q

CKD and CRF?

A

Chronic Kidney Disease, Chronic Renal Failure

32
Q

CRI?

A

Chronic renal insufficiency

33
Q

Key renal disorders

A
  • AKI
  • CKD
  • Nephrotic syndrome
  • Urolithiasis
34
Q

Potassium restriction in HD

A

2-3 g/day

35
Q

Potassium restriction in PD?

A

No restriction, +/- supplement

36
Q

Normal serum potassium?

A

3.5-5.5 mmol/L

37
Q

3 non-nutritional causes of hyperkalemia?

A
  • GI bleeding
  • Acidosis
  • Hypoaldosteronism
38
Q

Which drugs may raise potassium?

A
  • ACEi
  • ARBs
  • SARS (Selective Aldosterone Receptor Antagonists)
  • Potassium-sparing diuretics
  • Antifungals
39
Q

Increases in serum potassium up to ____can be expected when ACEi or ARB initiated with dosage increases

A

0.5 mmol/L

40
Q

High potassium foods?

A
  • Fruits (dried, juice, banana, avo)
  • Vegetables
  • Bran products, chocolate milk, molasses, nuts and seed, potassium salt (sodium replacements)
41
Q

Low potassium foods?

A
  • Apples, berries, grapes, pineapples
  • Some vegetables
  • Rice, noodles, pasta, coffee and tea
42
Q

How are fluid and sodium needs dictated by?

A
  • Needs according to urine output

- Needs according to type of dialysis

43
Q

If urine output is less that 1L/day, what is fluid and sodium restriction?

A

1-1.5 L and 2g of sodium

44
Q

If urine output greater than 1L per day, what is fluid and sodium restriction?

A

2L and 2-4 g of sodium

45
Q

Interdialytic weight gains should not exceed ____ of BW in HD

A

5%

46
Q

What is important to consider about fluids?

A

Anything that is liquid at room temperature is considered a fluid, including jello, ice-cream, smoothies etc.

47
Q

What is a practical suggestion to limit fluid intake?

A
  • But lemon/lime in water to attenuate thirst

- Freeze grapes and snack on them , low in K+ and refreshing

48
Q

Between dialysis, how will weight change?

A

Fluid will accumulate (as it cannot be excreted into the urine), which will impact blood pressure. This is expected to occur during both PD and HD
-We must interpret true dry weight with blood pressure, edema

49
Q

If we have high serum sodium, what is this indicative?

A
  • NOT diet

- Dehydration

50
Q

When is there no need for fluid or sodium restriction per patients BP?

A

Pre-dialysis

51
Q

Restriction of phos in HD and PD?

A

800-1000 mg/day or <17 mg/kg of IBW

52
Q

High phosphorus products?

A
  • Dairy products
  • Livers, oysters, sardines
  • Beans, lentils, chick peas
  • Bran, seeds, whole grains
  • *Many plant proteins**
53
Q

What is the goal regarding serum calcium?

A

Maintain between 8.4-10.12 mg/dl

54
Q

Calcium intake should not exceed ____

A

2,000 mg/day

Caution with Phos binders (<1500 mg/day)

55
Q

When we supplement calcitriol, what does it do? What is the negative impact?

A
  • Will suppress PTH excretion, which may be causing the excessive release of calcium and phosphate from the bones
  • However, the calcitriol could increase absorption of calcium and phosphate from the GIT, which would be counterintuitive
56
Q

Water-soluble vitamin supplementation?

A
  • Increases losses during PD and HD, often due to anorexia and poor intake
  • Difficult maintain with diet restriction and impaired synthesis, therefore supplementation can be ideal
57
Q

Which vitamin is not recommended to be supplemented in PD and HD?

A

Vitamin A, as serum levels are already elevated

58
Q

(T/F) Improper use of phosphate binders can increase the uptake of both calcium and phosphate

A

T, they will absorb on their own if they don’t have the chance to combine in the GI tracts to form the CaPO4 precipitate for excretion

59
Q

Which organ is responsible for the maintenance of serum magnesium?

A

Kidney

60
Q

What should be avoided to avoid excess mg?

A

-Laxatives
-Enemas
-Phos binders
As these commonly contain magnesium

61
Q

What is an unsuspected source of magnesium?

A

Water, check that water is low in Mg (hard water)

62
Q

How will we supplement for iron?

A

According to serum markers of ferritin, iron, total iron binding capacity and transferrin saturation

63
Q

What are patients undergoing maintenance HD know to have decreased levels of?

A

-Decreased levels of zinc in serum, hair and kidneys

64
Q

What amount of zinc supplementation may be appropriate in improving dysgeusia and impotence in male HD patients?

A

15 mg/day

65
Q

Is there selenium supplementation in dialysis?

A

Not right now, however plasma levels are low

66
Q

Are antioxidant supplements recommended?

A

Not yet

67
Q

What is the role of carnitine?

A

Involved in the transfer of FA into the mitochondria for oxiation
-Carnitine is removed by dialysis

68
Q

Carnitine supplementation?

A

Evidence insufficient for use, however may improve symptoms in certain patients

69
Q

What is the most promised application of carnitine tx?

A

Treatment of EPO-resistant anemia

70
Q

What is the proposed order of diet calculation?

A
  • Milk
  • Meat
  • F&V
  • Starches according to protein left
  • Fat

Clinical Nutrition 3 (30 decks)

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