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FNN 301 > Week 11 - Nephrology > Flashcards

Week 11 - Nephrology Flashcards

1
Q

the kidneys receive ____ % of total arterial blood pumped by the heart

A

20-25%

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2
Q

an adult’s kidney weighs ____ grams and is the size of ______

A

142 g
size of cellphone

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3
Q

Kidneys have higher blood flow compared to the brain and liver

A
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4
Q

how many nephrons are there in the body?

A

2 million

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5
Q

the nephrons in the body are ______ km long

A

8 km long

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6
Q

kidneys pump ____ litres of blood every day

A

1,514 litres

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7
Q

they kidneys are _____, which means they are behind the peritoneum

A

retroperitineal

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8
Q

the _______ connects the kidneys to the aorta.

the _____ connects the kidneys to the inferior vena cava

A

the renal artery connects the kidneys to the aorta

the renal vein connects the kidneys to the inferior vena cava

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9
Q

_______ is the functional unit of the kidneys

A

the nephron

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10
Q

_____ conducts urine within each nephron of the kidney

A

loop of henle

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11
Q

what is the primary function of the loop of henle?

A

to recover water and NaCl from urine

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12
Q

what do loop diuretics, like furosemide, do?

A

they decrease reabsorption of NaCl in the thick ascending limb of the loop of henle

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13
Q

what is the main function of bowman’s capsule?

A

it is a double walled chamber for filtering

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14
Q

What are the functions of the kidneys?

A

AWETBED

A - regulation of ACID/base balance
W - control fluid or WATER balance
E - maintain ELECTROLYTE balance
T - eliminate TOXINS
B - regulate BLOOD PRESSURE
E - produce ERYTHROPOIETEN, which is secreted by the kidneys
D - activates VITAMIN D and calcium uptake

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15
Q

What are the 3 main markers of renal function?

A
  1. glomerular filtration rate
  2. blood urea nitrogen (BUN)
  3. creatinine
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16
Q

what is the standard marker to show how much kidney function one has?

A

the GFR

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17
Q

how do you calculate the GFT, which is the main marker for kidney function?

A
  1. creatinine
  2. age
  3. body size
  4. gender

NOT ETHNICITY

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18
Q

the kidneys usually filter ____ L/day

A

135-10 L/day

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19
Q

what is a normal GFR (which is the main marker of renal function)?

A

90 mL / minute / 1.73m2 BSA

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20
Q

____ measures the amount of urea nitrogen, a protein waste product, in the blood

A

blood urea nitrogen (BUN)

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21
Q

____ measures how well the kidneys are working by determining the amount of creatinine in the blood

A

creatinine

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22
Q

creatinine measures depend on ______

A

amount of muscle tissue

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23
Q

who usually has higher creatinine numbers, men or women?

A

men

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24
Q

______ is a measure of muscle degeneration and protein waste

A

creatinine

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25
Q

what are 3 common types of renal disorders

A
  1. chronic kidney disease (CKD)
  2. acute kidney disease (AKD)
  3. nephrolithiasis (kidney stones)
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26
Q

what is the #1 cause of kidney disease?

A

diabetes

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27
Q

what do the different GFRs indicate?

A

> 90 mL/min = normal
15-89 mL/min = CKD
< 15 mL/min = end stage renal disease

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28
Q

how is one diagnosed with CKD (2 ways)?

A
  1. they have low GFR for 3 months
  2. GFR is 15-89 mL/min
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29
Q

_____ is the DECLINE in the kidneys ability to:

  1. excrete waste products
  2. maintain fluid and electrolyte balance
  3. produce hormones

while _____ is the kidneys INABILITY to:

  1. excrete waste products
  2. maintain fluid and electrolyte balance
  3. produce hormones
A

CKD is the decline
end renal stage is the inability

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30
Q

what are 4 causes of CKD?

A
  1. diabetes
  2. hypertension
  3. glomerulonephritis
  4. polycystic kidney disease
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31
Q

is CKD reversable?

A

NO! it is an IRREVERSIBLE disease of:

  1. glomerular function
  2. endocrine function
  3. renal function
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32
Q

what are the 5 stages of CKD?

A

stage 1: normal
stage 2: mild loss of function
stage 3: moderate loss of function
stage 4: severe loss of function - weakened bones, anemia
stage 5: kidney failure

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33
Q

how do we stop CKD from progressing to stage 5?

A
  1. control blood sugar < 7
  2. diet low in:
    - protein –> too much protein in urine is big cause of stage 5
    - salt
    - potassium
    - phosphorous
  3. medications
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34
Q

as kidney disease progresses…..

GFR _______
Creatinine _______
Blood urea ________

A

GFR decreases
Creatinine increases
blood urea increases

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35
Q

what is the main cause of chronic kdieny disease?

A

diabetic nephropathy

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36
Q

what is glomelur nephritis?

A

responsible for 15% of CKD in younger patients

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37
Q

what are 7 main causes of CKD?

A
  1. diabetes.
  2. age 60+
  3. tobacco use
  4. family history
  5. obesity
  6. heart problems
  7. high bp
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38
Q

_____ is the buildup of toxins in the blood (secondary to declining kidney function)

A

uremia

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39
Q

what are the signs and symptoms of uremia?

A
  1. high creatinine and BUN
  2. malaise
  3. weakness
  4. nausea and vomitting
  5. muscle cramps
  6. itching
  7. metallic taste
  8. neurological impairment
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40
Q

_____ % of patients beginning dialysis are malnourished

A

40%

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41
Q

when patients starting dialysis are malnourished, what are the main contributing factors?

A
  1. chronic inflammation
  2. anorexia from uremia
  3. removal of amino acids, peptides, and proteins during haemodialysis
  4. removal of protein during peritoneal dialysis
42
Q

do we lose more protein through haemodialysis or peritoneal dialysis?

A

peritoneal dialysis

43
Q

what are 4 key aspects of nutritional management for CKD?

A

1.t vitamin D in the form of calcitriol (and monitor calcium and phosphorous)

  1. ensure serum calcium is in normal limits. of not, take supplements
  2. need renal specific water soluble vitamins
  3. take iron supplement (erythropoietin stimulating agent)
44
Q

What are the main medications in CKD?

A
  1. ACE inhibitors (prils)
  2. loop diuretics (semide)
  3. dyslipedmia medications (statins)
  4. anticoagulants (arin)
  5. vitamins
  6. corticosteroids - IN TRANSPLANT POPULATIONS
  7. diabetic management
  8. anemia management
  9. constipation management
45
Q

what are the 3 options for renal replacement therapy?

A
  1. transplant
  2. haemodialysis
  3. peritoneal dialysis
46
Q

what are the 3 types of schedules for haemodialysis?

A
  1. conventional - 2.5-4 hrs, 3x per week
  2. daily schedule - 2 hrs, 6-7x per week
  3. nocturnal schedule - 6 hrs per night, every night
47
Q

when one gets a kidney transplant, where is the donor kidney placed?

A

in the lower abdomen

48
Q

What are the differences between PD and and HD?

A

PD
- not as common, because self management is intimidating
- not as efficient in removing solutes and water from the body

Patients can:
- remain ambulatory
- provide their own care
- have fewer dietary restrictions

weight gain

removes less phosphorous than HD

49
Q

what are some long term complications of dialysis?

A
  1. anemia
  2. coagulopathy - excessive bleeding or clotting
  3. dyslipedmia
  4. malnutrition
  5. weight gain (PD) or weight loss (HD)
50
Q

PD leads to weight ____ while HD leads to weight _____

A

PD leads to weight gain while HD leads to weight loss

51
Q

we usually want hemoglobin levels to be _____
for CKD/dialysis, hemoglobin levels are _____

A

want them to be 130
they are 100-120

52
Q

albumin levels during CKD

A

35-50

53
Q

when on dialysis, we want calcium lebels to be lower to protect bones

A
54
Q

what is the role of the renal dietitian?

A
  1. assess the big picture / medical history
  2. counsel / reocmmend
  3. develop / modify plan of care
55
Q

how much sodium should people with CKD eat per day?

A

2000 mg/day

56
Q

why do we want to restrict sodium with CKD? it helps manage:

A
  1. excessive thirst
  2. edema
  3. hypertension
  4. CHF
57
Q

what are various nutrients you need to control with CKD? (stage 3 or later)

A
  1. energy = 25-35 kcal / IBW
  2. protein 0.6-0.8 g/kg IBW
  3. sodium - 2000 mg/day
  4. phosphorous - 0.8-1g/day
  5. potassium - 2000 mg/day - 4000 mg/day
  6. fluids - unrestricted
58
Q

what are various nutrients you need to control for end stage renal disease on haemodialysis?

A
  1. energy = 25-40 kcal dry weight
  2. protein 0.9-1 g/kg dry weight
  3. sodium - 3000 mg/day
  4. phosphorous - 0.8-1g/day
  5. potassium - 2000 mg/day
  6. fluids - 1000 mL/d + urine output
59
Q

what are various nutrients you need to control for end stage renal disease on peritoneal dialysis?

A
  1. energy = 25-35 kcal dry weight
  2. protein = 1-1.3 g/kg dry weight
  3. sodium - 3000 mg/day
  4. phosphorous - 0.8-1g/day
  5. potassium - individualized
  6. fluids - individualized
60
Q

CaCO3, Tums, renagel, and fosregnol are:

A

phosphorous binders

61
Q

why do we need to achieve normal serum phosphate with CKD? to prevent:

A
  1. hyperphosphatemia
  2. secondary hyperparathyroidism
  3. renal osteodystrophy
62
Q

do we stillneed to restrict phosphorous in CKD if serum phosphorous and PTH levels are normal?

A

yes - but focus onr estricting inorganic phosphorous

63
Q

what are signs and symptoms of secondary hyperparathyroidism in cKD patients?

A

disabling bone pain
fractures/bone deformaties
bone cysts
ostweopenia

64
Q

CKD leads to less phosphorous leaving body, leads to more phosphorous and FGF in blood, leads to decreased vitamin D and calcium –> secondary hyperparathyroidism

A
65
Q

how to treat secondary hyperparathyroidism?

A

restrict INORGANIC phosphorous to 0.8-1g/day per day

take phsophate binders

vitamin D analogue

66
Q

what are the treatments for secondary parathyroidism?

A
  1. medical nutrition therapy (restriction to 0.8-1 g of inorganic phosphorous/day)
  2. medication
  3. dialysis
  4. surgery - parathyroidectomy
67
Q

when do you resort to a parathyroidectomy for secondary parathyrodisim?

A

if pth levels are > 88 pmol/L
if hypercalcemia
if disabling bone pains

68
Q

why is it better to have prganic phosphorous than inorganic phosphorous?

A

because with inorganic phosphorous, 100% of it is absorbed

69
Q

what happens if yo udont restrict phosphorous in CKD? what happens if you do restrict phosphorous?

A

calcification
adynamic bone disease
MBD (mineral and bone disease)

if you do restrict:
- malnutrition from inadequate protein

70
Q

what is renal osteodystrophy

A

a complication of chronic kidney disease that weakens your bones.

as GFR decreases, less phosphorous is excreted. high serum phosphorous = low serum calcium.

high phosphorous + low calcium = PTH synthesis and secretion –> DECREASED VITAMIN D CONVERSION = bone problems

71
Q

if people have transplant, do they need high or low phosphorous diet?

A

high phosphorous diet

72
Q

nuts, chocolate, processed foods, dairy, are all sources of:

A

phosphorous

73
Q

restriction of phosphorous prevents:

A
  1. bone decalcification
  2. soft tissue calcification
  3. secondary hyperparathyroidism
  4. itchy skin
74
Q

how much phosphorous from chocolate, nuts, legumes gets absorbed?

A

10-30%

75
Q

how much phosphorous from whole grains, brown rice, meat get absorbed?

A

40-60%

76
Q

list the order of phosphorous content from high to low:

chicken breast
white break
milk
almonds

A

milk > almonds > white bread > chicken breast

77
Q

boiling foods helps remove _____

A

phosphorous

78
Q

proteins are high in phosphorous

A
79
Q

what 4 foods to include in phosphorous restricted diets?

A
  1. fresh or frozen meat and fish
  2. limited cheese
  3. limited milk
  4. whole grain
80
Q

people who have impaired renal function and hyperkalemia may need a potassium restricted diet

A
81
Q

people on which medications need a potassium restricted diet?

A

ACE inhibitors
angiotensin receptor blockers

82
Q

restriction of ______ helps prevent cardiac arrhythmias

A

potassium

83
Q

high potassium foods include:

A

bananas
avocados
orange
potato
squash

Low potassium foods: apple, pineapple, berries

84
Q

Which 4 foods should we avoid because of excess potassium

A

starfruit
potato - double boil
sweet potato - double boil
yam - double boil

85
Q

when should you restrict fluids in CKD/ESRD?

A
  1. patients with edema
  2. patients with congestive heart failure
  3. uncontrolled hypertension
86
Q

examples of fluid output include:

A
  1. urine and stool
  2. insensible loss
  3. sweating
  4. fever
  5. wound
  6. diuretics
87
Q

fluid intake includes anything liquid at body temp. this includes:

A

ice
gelatin
popsicles
soup
ice cream

88
Q

5 tips to control thirst

A
  1. avoid salty foods
  2. swallow pills with food
  3. use small cups
  4. sip fluid slowly
  5. eat frozen fruit
89
Q

_____ is the abrupt decline iN GFG, USUALLY REVERSIBLE. cant maintain fluid, electrolyte, and acid-base balance

A

acute kidney injury

90
Q

is acute kidney injury reversible?

A

usually

91
Q

how do we diagnose AKI?

A
  1. creatinine increased by 26 mmol/l in 48 hours
  2. creatinine increased by 1.5x in past week
  3. urine output < 0.5 mL/kg/hr for MORE THAN 6 HOURS
92
Q

who gets AKI?

A

people in hospital, on drugs, chemo, MRI scan medication

93
Q

what are 5 main causes of AKI?

A
  1. severe dehydration
  2. fluid losses from burns
  3. exposure to toxins
  4. systemic inflammatory conditions like sepsis
94
Q

what is olguria?

A

< 500 ml of urine output per day

95
Q

what are clinical manifestations of AKI?

A

< 500 ml urine output

hypercatabolic - increased potassium, magnesium, phosphorous (but can also be low)

increased BUN and creatinine

96
Q

_____ is the imbalance between solubility and precipitation of mineral salts in the urine, resulting in supersaturation

A

nephrolithiasis (kidney stones)

97
Q

what are risk factors for nephrolithiasis?

A
  1. family history
  2. low urine output
  3. gout
  4. excess vitamin D or calcium intake
  5. UTIs
98
Q

what are the signs and symptoms of nephrolithiasis?

A

NONE until stone is moved into ureter

99
Q

how do you diagnose nephrolithiasis?

A
  1. intravenous pyelogram
  2. x-ray
  3. renal ultrasound
  4. analysis of urine
100
Q

if the stone cant be passed, how d you treat it?

A
  1. extracorporeal shock wave lithotripsy (EWSL)
  2. percutaneous nephrolithotomy
  3. ureterorenoscopy and extraction
101
Q

nutrition therapy in kidney stones - things to look out for:

A
  1. balanced ph
  2. lots of hydration - 2.5 L
  3. enough calcium - 1000 - 1200 mg/day
  4. low oxalate - restrict to 100 mg/day
  5. low uric acid
  6. low sodium
  7. high citrate through fruit and veggies

limit vitamin C to 1000 mg
avoid excess protein - 0.8 to 1 g/kg
reduce purine foods

102
Q

what is an apprporiate PES statement relation to kidney stones?

A
  1. EXCESSIVE MINERAL INTAKE
  2. INADEQUATE FLUID INTAKE
  3. NUTRITION RELATED KNOWLEDGE DEFICIT

FNN 301 (10 decks)

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