Renal Disease

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Renal Disease
2012-04-01 23:15:18
Medical Nutrition Therapy

kidney disease
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  1. What is the unit of the kidney structure and function?
    the nephron is the unit of kidney structure and function.
  2. What are the main functions of the kidney?
    • - regulation of hte volume and composition of extracellular fluid
    • -regulation of acid-base balance by excreteing excess base (HCO3-) or acid (H+) as required in order to maintain body hemeostasis, and by synthesizing ammonia
    • - elimination of waste products of metabolism, foreign compounds, and toxins by excreting them into the urine
    • - Production of hormones
    • - erythropoietin, Active Vitamin D, Aldosterone
    • - Degradation of hormones
    • - insulin, glucagon, PTH
  3. Approximately one in ______ North American adults has chronic kidney disease
  4. People in these population groups have increased risk of developing chronic renal disease due to high rates of hypertension and/or diabetes mellitus, except
    A.) African Americans
    B.) Pacific Islanders
    C.) Hispanics
    D.) Jewish
    E.) First nations
    D. ) Jewish
    (this multiple choice question has been scrambled)
  5. What is creatinine and how is it excreted?
    creatinine is a waste product of muscle metabolism. It is a nitrogen-containing substance derived from creatine phosphate. It is produced by the muslces and appears in the blood and is excreted into urine by the kidneys.
  6. How does the body catabolize the nitrogen group of amino acids?
    The alpha amino nitrogen of amino acids is metabolized through deamination into ammonia by the liver. Ammonia, which is highly neurotoxic, is then degraded through the urea cycle in the liver. The urea cycle disposes the nitrogen from amino acids into nontoxic urea. Urea is released into the blood and finally excreted by the kidneys in the urine.
  7. What is the active form of Vitamin D and where is it activated ?
    The active form of vitamin D is 1,25-dihydroxy vitamin D3 and it is activated by hyroxylation in the kidneys
  8. What is separation of molecules in solution by diffusion through a selectively permeable membrane on the basis of molecule size and concentration gradient?
  9. In a healthy individual, the 24-hour urinary excretion of __________ is proportionate to the skeletal muscle mass of the individual. It can be used as a tool to help estimate body protein status.
  10. Foods rich in phosphorus:
    milk, cottage cheese, fudge ice cream, lima beans, pork, cooked mushrooms, salmon, seeds, nuts, lentils, baked beans, veal liver, chocolate, cola beverages, whole wheat bread, sweet potato, egg, yogurt, peanut butter, pea soup, tofu, soy milk, granola cereal, corn tortilla, sardines, pancake, beer, bran cereal, and vanilla cake
  11. foods rich in potassium:
    milk, cottage cheese, banana, tomato, fudge ice cream, lima beans, prune juice, orange, pork, cooked mushrooms, salmon, seeds, nuts, baked potato, avocado, lentils, baked beans, winter squash, veal liver, molasses, chocolate, potato chips, cantaloupe, french fries, dried fruits, kiwifruit, peach, nectarine, sweet potato, yogurt, peanut butter, pea soup, tofu, granola cereal, sardines, bran cereals and salt substitutes
  12. What is the accumulation of exces body fluids in cells, tissues, or serous cavities, often causing swelling of extremities, such as the feet, hands, legs, and face?
  13. _________ is the most abundant intracellular cation.
  14. Why is high blood potassium concentration considered to be a dangerous state?
    high blood potassium concentration causes stress on the heart and can cause arrhythmias and heart attack
  15. CKD
    Chronic kidney disease
  16. ESRD
    End-stage renal disease
  17. AFR
    Acute renal failure
  18. CRF
    Chronic renal failure
  19. UTI
    Urinary tract infection
  20. ATN
    Acute tubular necrosis
  21. BUN
    Blood urea nitrogen
  22. SUN
    Serum urea nitrogen
  23. UA
  24. UUN
    Urine urea nitrogen or urinary urea nitrogen
  25. UNA
    Urea nitrogen appearance
  26. Osm
  27. UOsm
    Urine osmolality
  28. mEq
  29. GFR
    Glomerular filtration rate
  30. URR
    Urea reduction rate
  31. RTA
    Renal tubular acidosis
  32. Cr
  33. Urine ACR
    Urinary albumin-to-creatinine ratio
  34. EPO
  35. PTH
    parathyroid hormone
  36. PNA
    protein equivalent of total nitrogen appearance or protein nitrogen appearance
  37. nPNA
    Normalized protein nitrogen appearance
  38. DPI
    Dietary protein intake
  39. HBV
    high biological value
  40. MDRD
    Modification of diet in renal disease
  41. CAPD
    Continuous ambulatory peritoneal dialysis
  42. APD
    Automated peritoneal dialysis
  43. CPD
    Chronic peritoneal dialysis
  44. MD
    maintenance hemodialysis or medical doctor
  45. HD
  46. MHD
    maintenance hemodialysis
  47. CAVH
    Continuous arteriovenous hemofiltration
  48. CAVHD
    Continuous arteriovenous hemofiltration with concurrent hemodialysis
  49. CVVH
    Continuous venovenous hemofiltration
  50. CVVHD
    Continuous venvenous hemofiltration with concurrent hemodialysis
  51. CRRT
    Continuous renal replacement therapy
  52. IDWG
    Interdialytic weight gain
  53. ACEI
    Angiotensin-converting enzyme inhibitor
  54. ARB
    angiotensin receptor blocker
  55. CCB
    calcium channel blocker
  56. KDOQI guidelines
    Kidney disease outcomes quality initiative guidelines
  57. The kidneys are responsible for maintaining blood pH at ___________
    7.35 - 7.45
  58. What clients are susceptible to developing acute renal failure?
    intensive care clients with multiple organ failure, trauma, burns, or sepsis are susceptible to developing acute renal failure.
  59. What medical abnormalities are seen in clients with acute renal disease?
    • - reduced urine production
    • - blood electrolyte abnormalities, such as high blood potassium and phosphorus concentrations
    • - abnormal fluid status
    • - acidosis
    • -hyperglycemia
    • -elevated blood urea and creatinine concentrations
  60. There are three categories of acute renal failure, based on the etiology of the problem affecting the kidneys. What are they?
    • a.) The prerenal category, when the amount of blood entering the kidney is redued
    • b.) The intrarenal category, when there is damage to the kidney
    • c.) The postrenal category, when there is hindrance to urine release
  61. What type of diet is recommended for clients with acute renal failure?
    • acute renal failure:
    • protein restriction for those not on dialysis: 0.8-1.0 g/kg
    • Increased protein for those on dialysis: 1.2-1.5 g/kg
    • -usually restricted in potassium, sodium, and fluids controlled in energy, phosphorus, and calcium.
    • - Thier energy intake may need to be increased because of clinical stress and malnutrition
    • - water soluble vitamin supplementation may be necessary to replenish losses due to dialysis
  62. What factors should you keep in mind when making nutritional recommendations for clients with acute renal failure?
    • -these clients may not be able to eat, possibly due to nausea & vomiting
    • - the presence and degree of body protein catabolism in the diet
    • - the degree of clinical stress
    • - the nutrtional status of the client
    • - the renal function of the client or absense of thereof
    • - the underlying problem and category of acute renal failure
    • - the treatments recommended by the nephrologist and multidisciplanary health care team
    • - the presence of comorbidities
    • - the electrolyte and fluid status of the client
    • - the need for nutrition support
    • - these clients are usually unstable and their staus should be monitored regularly
  63. Explain the five stages of the development of chronic kidney disease.
    • Stage 1- there is damage to the kidneys, which causes proteinuria, but the glomerular filtration rate is still normal, at more than 90 mL/min. The GFR can be slightly elevated.
    • Stage 2- Kidney damage progresses and the GFR is mildly decreased (between 60 and 89 mL/min)
    • Stage 3- The GFR is moderately decreased to 30-59 mL/min
    • Stage 4- The GFR falls below 30 mL/min (15-29mL/min), which is a severe decrease
    • Stage 5- End-stage renal disease. The GFR is < 15 mL/min, which is characterizes kidney failure. Dialysis or kidney transplantation is required.
  64. What are metabolic and clinical consequences of chronic kidney disease?
    • the kidneys become progressively less and less able to perform their normal physiologic functions, including removing waste products from blood, such as protein waste products, which increase in the blood to toxic levels. Ultimately, there is renal failure.
    • Other associated consequences include:
    • -fluid & electrolyte imbalances
    • - catabolism & protein-energy malnutrition
    • -abnormalities of phosphorus, vitamin D, and calcium metabolism
    • - anemia
    • -hyperlipidemia
    • -alteration of carbohydrate metabolism
  65. What are the symptoms caused by increased levels of urea in the blood or uremic symptoms?
    -weakness, nausea & vomiting, itchy skin, fatigue, feeling ill, muscle cramping, anorexia, insomnia, irritability, trouble concentrating, and reduced comprehension.
  66. What are the two main goals of nutrition management for clients with pre-end-stage renal disease?
    • a.) to help clients meet their needs and maintain a good nutritional status
    • b.) to provide nutrition education/counseling to help slow the progression of renal insufficiency, which will assist in preventing or minimizing metabolic complications
  67. What type of diet is recommended for clients with
    a diet mainly reduced in protein, phosphorus, and sodium. The diet may also need to be controlled in potassium, fluids, and energy to meet their individual needs. The amount of energy in the diet should allow for maintaining a healthy body weight, even though the amount of protein and phosphorus are reduced in the diet.
  68. What level of dietary protein restriction is usually required for clients with pre-ESRD?
    Clients with Pre-ESRD (CKD stage 1-4) require a dietary protein restriction of 0.6-0.8 g protein per kg desirable body weight daily, with at least half of the protein from high biological value
  69. Effects of too much protein intake in clients with pre-ESRD
    • -tiredness, fatigue
    • -nausea
    • -vomiting
    • -anorexia
    • -headache
    • -malaise
    • -bad taste in mouth
    • -uremic symptoms
  70. Effects of too little protein intake in Pre-ESRD?
    • -lack of energy, weakness
    • - weight loss
    • -muscle loss, wasting
    • -poor wound healing
    • -reduced ability to fight infections
    • -malnutrition
  71. What amount of energy is recommended for clients with Pre-ESRD?
    35 kilocalories per kilogram body weight daily for adult clients under 60 years of age, and slightly less (30-35 kilocalories/kg/day) for older adults
  72. What amount of phosphorus is generally recommended for clients with pre-ESRD?
    phosphorus restricted to 0.8-1.0 g when serum phosphorus or parathyroid hormone concentration is elevated. Monitoring of laboratory test result values is required.
  73. What amount of sodium is generally recommended for clients with Pre-ESRD?
    Sodium restricted to 1.0 -3.0 g or about 2 g daily. Clients with salt-losing nephropathies need more sodium
  74. What amount of potassium is generally recommended for clients with Pre-ESRD?
    Dietary potassium is usually restricted in Pre-ESRD. However, dietary potassium recommendation is based on individual serum potassium concentration. Dietary potassium is restricted when serum potassium is high and urine output is < 1.1 quarts/day. dietary potassium is increased or supplemented when clients are taking potassium wasting diuretics and their serum potassium concentration is low.
  75. What amount of calcium is generally recommended for clients with Pre-ESRD?
    1000-1500 mg or about 1200 mg calcium daily, with no more than 2000 mg daily with phosphate binders (which contain calcium)
  76. Which renal patients may require a fluid restriction?
    • - Pre-ESRD clients who have edema
    • - Pre-ESRD clients with congestive heart failure
    • - Clients with ESRD
    • - Renal clients with uncontrolled hypertension
  77. In clients with chronic renal insufficiency, the hormone __________ is no longer normally synthesized by the kidneys and may need to be given to clients to treat anemia and stimulate the formation of erythrocytes
  78. Vitamin _________ supplementation is associated with toxicity in patients with chronic renal insufficiency.
    Vitamin A
  79. What type of medications given to clients with nephrotic syndrome to reduce their proteinuria and help normalize their blood pressure?
    ACE inhibitor
  80. The following are associated with ESRD except:
    A. ) back pain
    B.) blood in the urine
    C.) Fatigue
    D.) dehydration
    E.) high blood pressure
    D.) dehydration
    (this multiple choice question has been scrambled)
  81. What are the main types of renal disorders?
    • -chronic kidney disease
    • -acute renal failure
    • -nephrotic syndrome
    • -kidney stones and urinary tract stones
    • -kiney infection resulting from urinary tract infection
  82. _____________ is the branch of medicine studying kidney anatomy, physiology, and pathology.
  83. ___________ are specialists of the kidneys, their diseases, and medical management
  84. ___________ is a general term referring to an abnormal condition of the kidneys due to disease.
  85. ___________ is kidney inflammation, which can be acute or chronic.
  86. __________ is kidney pain.
  87. _________ is when renal tissue is hardened with reduced blood flow. It is often caused by hypertension.
  88. _____________ is a disease condition of the kidneys, such as nephrotic syndrome, altering the function of nephrons but without causing inflammation.
  89. ____________ is an abnormal kidney condition causing clinical signs of edema, marked proteinuria, low blood albumin concentration, and hyperlipidemia due to increased glomerular permeability as a result of glomerular injury.
    nephrotic syndrome
  90. _________ is a clinical state of severe glomerulonephritis with blood in urine, high blood as a result of glomerular injury.
    nephritic syndrome
  91. ____________ qualifies a state of excess urea in blood.
  92. __________ is an abnormally high amount of protein in urine.
  93. __________ is the abnormal presence of albumin in the urine.
  94. ____________ is the abnormal presence of blood or erythrocytes in the urine.
  95. ____________ means high blood sodium concentration.
  96. ______________ means high blood potassium concentration.
  97. _______________ is the analysis of urine using biochemical tests, including determination of urine pH; specific gravity; presence of blood, glucose, ketones, nitrite, and leukocyte esterase in urine; and concentration of bilirubin, protein, and urobilinogen of urine.
  98. The ____________ is the liquid collected after dialysis taht went through the selectively permeable membrane.
  99. A _______________ is an apparatus or piece of equipment to accomplish dialysis and that contains dialyzing membranes.
  100. ____________ is the radiography of kidneys
  101. ____________ is the excision of both kidneys by surgery.
    bilateral nephrectomy
  102. kidneys are important for the activation of vitamin ______
    Vitamin D
  103. What is the main waste product of amino acid catabolism?
  104. the two most common causes of chronic kidney disease are ________ and ___________
    hypertension and diabetes mellitus
  105. Which of the following two healthy individuals has the highest plasma creatinine concentration: a young adult man or an elderly woman? Why?
    A young man has a higher plasma creatinine concentration because he has more muscle mass than the elderly women. Creatinine is made from the break down of creatine phosphare in the muscle, the more muscle the more creatine phosphate that is broken down.
  106. Do high protein diet cause chronic renal failure? Explain.
    No, there is no scientific evidence that high protein diet causes CRF.
  107. One of your renal patients on a fluid restriction is suffering from thirst. Give 10 practical tips to help him control his fluid intake and reduce his thirst.
    • 1. Swish water around in the mouth
    • 2. fill up a pitcher at the beginning of the day and pour out water as you drink liquids
    • 3. sucking on hard candy
    • 4. sucking on ice cubes
    • 5. use a smaller glass
    • 6. drink slowly
    • 7. don't use it taking medications
    • 8. add lemon juice to it
    • 9. chew gum
    • 10. avoiding salty foods
    • 11. using frozen or juicer foods in the diet, ex. peaches
  108. A low-protein, low-phosphorus diet is recommended for clients with pre-ESRD for the following reasons:
    • -to limit waste product build up and slow development of renal disease
    • -prevent further loss of calcium
  109. These statements about the PTH are true except:
    A.) it decreases bone resorption
    B.) it decreases kidney reabsorption of phosphorus
    C.) it increases calcium reabsorption by the kidneys
    D.) its production decreases in response to an increase in serum calcium concentration
    E.) it increases calcitriol production by the kidneys
    A.) it decreases bone resorption
    (this multiple choice question has been scrambled)
  110. These foods are high in potassium except:
    A.) seeds
    B.) cola beverages
    C.) baked potatoes
    D.) bananas
    E.) melons
    B.) cola beverages
    (this multiple choice question has been scrambled)
  111. These foods are high in phosphorus, except:
    A.) nuts
    B.) oranges
    C.) chocolate
    D.) liver
    E.) baked beans
    B.) oranges
    (this multiple choice question has been scrambled)
  112. The protein and energy needs of clients with pre-ESRD are ________g and _____________kcals/kg ideal/desirable body weight per day, respectively.
    0.8; 35
  113. In a catabolic client, cell breakdown releases __________, which increases in the blood.
  114. High serum ________________ concentrations make clients feel very itchy and causes muscle spasms.
  115. Low serum ______________ concentration is the biggest predictor of morbidity and mortality in clients with renal disease.
  116. Which abnormal biochemical test values are typically seen in clients with nephrotic syndrome?
    • - decreased albumin
    • - increased blood lipids
    • - increased protein in the urine
    • - edema
  117. What is the only cure for clients with end-stage renal failure?
    a transplant
  118. In clients using continuous ambulatory peritoneal dialysis, the ____________ serves as a natural dialyzing membrane.