What is the unit of the kidney structure and function?
the nephron is the unit of kidney structure and function.
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
Approximately one in ______ North American adults has chronic kidney disease
nine
People in these population groups have increased risk of developing chronic renal disease due to high rates of hypertension and/or diabetes mellitus, except
C. ) Jewish
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.
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.
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
What is separation of molecules in solution by diffusion through a selectively permeable membrane on the basis of molecule size and concentration gradient?
dialysis
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.
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?
edema
_________ is the most abundant intracellular cation.
potassium
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
CKD
Chronic kidney disease
ESRD
End-stage renal disease
AFR
Acute renal failure
CRF
Chronic renal failure
UTI
Urinary tract infection
ATN
Acute tubular necrosis
BUN
Blood urea nitrogen
SUN
Serum urea nitrogen
UA
urinanalysis
UUN
Urine urea nitrogen or urinary urea nitrogen
UNA
Urea nitrogen appearance
Osm
Osmolality
UOsm
Urine osmolality
mEq
Miliequivalents
GFR
Glomerular filtration rate
URR
Urea reduction rate
RTA
Renal tubular acidosis
Cr
Creatinine
Urine ACR
Urinary albumin-to-creatinine ratio
EPO
erythropoietin
PTH
parathyroid hormone
PNA
protein equivalent of total nitrogen appearance or protein nitrogen appearance
nPNA
Normalized protein nitrogen appearance
DPI
Dietary protein intake
HBV
high biological value
MDRD
Modification of diet in renal disease
CAPD
Continuous ambulatory peritoneal dialysis
APD
Automated peritoneal dialysis
CPD
Chronic peritoneal dialysis
MD
maintenance hemodialysis or medical doctor
HD
hemodialysis
MHD
maintenance hemodialysis
CAVH
Continuous arteriovenous hemofiltration
CAVHD
Continuous arteriovenous hemofiltration with concurrent hemodialysis
CVVH
Continuous venovenous hemofiltration
CVVHD
Continuous venvenous hemofiltration with concurrent hemodialysis
The kidneys are responsible for maintaining blood pH at ___________
7.35 - 7.45
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.
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
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
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
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
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.
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
What are the symptoms caused by increased levels of urea in the blood or uremic symptoms?
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
What type of diet is recommended for clients with
pre-ESRD?
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.
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
Effects of too much protein intake in clients with pre-ESRD
-tiredness, fatigue
-nausea
-vomiting
-anorexia
-headache
-malaise
-bad taste in mouth
-uremic symptoms
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
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
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.
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
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.
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)
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
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
erythropoietin
Vitamin _________ supplementation is associated with toxicity in patients with chronic renal insufficiency.
Vitamin A
What type of medications given to clients with nephrotic syndrome to reduce their proteinuria and help normalize their blood pressure?
ACE inhibitor
The following are associated with ESRD except:
D. ) dehydration
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
_____________ is the branch of medicine studying kidney anatomy, physiology, and pathology.
nephrology
___________ are specialists of the kidneys, their diseases, and medical management
nephrologists
___________ is a general term referring to an abnormal condition of the kidneys due to disease.
nephropathy
___________ is kidney inflammation, which can be acute or chronic.
Nephritis
__________ is kidney pain.
nephralgia
_________ is when renal tissue is hardened with reduced blood flow. It is often caused by hypertension.
nephrosclerosis
_____________ is a disease condition of the kidneys, such as nephrotic syndrome, altering the function of nephrons but without causing inflammation.
Nephrosis
____________ 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
_________ is a clinical state of severe glomerulonephritis with blood in urine, high blood as a result of glomerular injury.
nephritic syndrome
____________ qualifies a state of excess urea in blood.
uremia
__________ is an abnormally high amount of protein in urine.
proteinuria
__________ is the abnormal presence of albumin in the urine.
albuminuria
____________ is the abnormal presence of blood or erythrocytes in the urine.
Hematuria
____________ means high blood sodium concentration.
hypernatremia
______________ means high blood potassium concentration.
hyperkalemia
_______________ 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.
urinanalysis
The ____________ is the liquid collected after dialysis taht went through the selectively permeable membrane.
dialysate
A _______________ is an apparatus or piece of equipment to accomplish dialysis and that contains dialyzing membranes.
dialyzer
____________ is the radiography of kidneys
nephrography
____________ is the excision of both kidneys by surgery.
bilateral nephrectomy
kidneys are important for the activation of vitamin ______
Vitamin D
What is the main waste product of amino acid catabolism?
urea
the two most common causes of chronic kidney disease are ________ and ___________
hypertension and diabetes mellitus
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.
Do high protein diet cause chronic renal failure? Explain.
No, there is no scientific evidence that high protein diet causes CRF.
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
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
These statements about the PTH are true except:
C. ) it decreases bone resorption
These foods are high in potassium except:
C. ) cola beverages
These foods are high in phosphorus, except:
C. ) oranges
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
In a catabolic client, cell breakdown releases __________, which increases in the blood.
potassium
High serum ________________ concentrations make clients feel very itchy and causes muscle spasms.
phosphorus
Low serum ______________ concentration is the biggest predictor of morbidity and mortality in clients with renal disease.
albumin
Which abnormal biochemical test values are typically seen in clients with nephrotic syndrome?
- decreased albumin
- increased blood lipids
- increased protein in the urine
- edema
What is the only cure for clients with end-stage renal failure?
a transplant
In clients using continuous ambulatory peritoneal dialysis, the ____________ serves as a natural dialyzing membrane.
