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What is the unit of kidney structure and function?
What are the main functions of the kidneys?
- Maintain homeostatic balance of fluids, electrolytes and organic solids
- Renin-Angiotensin mechanism is a major control over BP
- Produces the hormone erythropoirtin, w/o cant make cells
- Maintenance of calcium-phosphorus homeostasis
What is creatinine and how is it excreted?
Creatinine is produced by the muscles and a result of muscle metabolism. It is excreted into the urine by the kidney.
How does the body catabolize the nitrogen group of AA?
N of AA is metabolized through deamination into ammonia by the liver. Ammonia enters the urea cycle in the liver and is released into the blood and finally excreted by the kidney into urine.
What is the active form of vitamin D and where is ti activated?
Vitamin D active is 1,25-dihydroxy vit D3, it is activated by hydroxylation in the kidney.
What is the separation of molecules in solution by diffusion through a selectively permeable membrane on the basis of molecule size and concentration gradient?
What is proportionate to the skeletal muscle mass of the individual and can therefore be used as a tool to help estimate body protein after a 24-hour urinary excretion in a healthy individual?
What is the accumulation of excess body fluids in cells, tissues, or serous cavities, often causing sell of the extremities, such as the feet, hands, legs, and face?
What is the most abundant intracellular cation?
Why is high blood potassium concentration considered to be a dangerous state?
Potassium is closely associated with muscle contraction which can cause stress on the heart, arrhythmia, or MF.
How are the fluid needs of healthy adults estimated?
- 1mL/kcal (The larger you are the more you need-SA)
- OR 30-35 mL/kg
- 30mL/kg it over the age of 56
What branch of medicine studies kidney anatomy, physiology, and pathology?
Specialists of the kidneys, their diseases, and medical mamagement?
What is the general term referring to an abnormal condition of the kidney due to disease?
What is kidney inflammation that can be acute or chronic?
What is the term for kidney pain?
Renal tissue hardening with reduced blood flow, often caused by hypertension?
What 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?
What is a state of excess urea in blood?
What is an abnormally high amount of protein in urine?
What is the abnormal presence of albumin in the urine?
What is the abnormal presence of blood or erythrocytes in the urine?
High blood Na concentration?
High blood potassium concentration?
The analysis of urine using biochemcial tests, including determination of urine pH; specific gravity; presence of blood, glucose, ketones, nitrite, and leukocytes esterase in urine; and concentration of billrubin, protein, and urobilinogen of urine.
What is the liquid collected after dialysis that went through the selectively permeable membrane?
What is an apparatus or piece of equipment to accomplish dialysis and that contains dialyzing membranes.
What is radiography kidneys?
What is the excision of both kidneys by surgery?
The kidneys are responsible fir maintaining blood pH at?
Who is susceptible to developing acute renal failure?
Multiple organ failure: Trauma, burns, sepsis
What metabolic abnormalities are seen in clients with acute renal failure?
- Reduced urine production
- Elevated blood urea and creatineine concentration
What are the 3 categories of acute renal failure, based on the etiology of the problem affecting the kidneys. What are they?
- a)The prerenal category
- Intrarenal category
- Postrenal category
What type of diet is recommend for clients with acute renal failure?
- Limit PRO .6-.8g/kg/day essential & nonessential AA
- Restrict Na & K
- Kcals 30-35 kcals/kg/day
- 60% CHO, 20-35% Fat
- TPN >5 days; 50-100 lipids as emulsion
What factors should you keep in mind when making nutritional recommendations for clients with acute renal failure?
- May feel really ill, N/V
- Ways to get kcals w/o protein, so they don't break down body PRO
- Electrolyte & fluid status of client
Explain the 5 stages of the development of chronic kidney disease?
- 1. Kidney Damage, proteinuria, GFR is normal at more than 90mL/min - may be elevated
- 2. Kidney damage, GFR slightly decreased 60-89mL/min
- 3. GFR moderately decreased 30-59 mL/min
- 4. GFR falls below 30 mL/min (15-29mL/min)-severe decrease
- 5. End-Stage Renal Disease, GFR <15mL/min. Characterizes kidney failure, dialysis or organ replacement required.
What are the metabolic and clinical consequences of CKD?
- Fluid & electrolyte imbalances
- Catabolism & protein-energy malnutrition
- Abnormalities of phosphorus, Vit D & Ca metabolism
- Alteration of CHO metabolism
What are the symptoms caused by increased levels of urea in the blood and uremic symptoms?
Itchy, skin, tired, N/V, trouble concentrating
What are the two main goals of nutrition management for clients with pre-endstage renal disease?
- 1. Maintain adequate PRO/kcal nutrition/delay progression
- 2. Maintain lab values within acceptable limits (K, phosphorus, albumin, Na)
What type of diet is recommended for clients with pre-ESRD?
Require a diet mainly reduced in PRO, phosphorus, and Na. May need to control K, fluids, and energy to meet individual needs.
What level of protein restriction is usually required for clients with pre-ESRD?
0.6-0.8g/PRO/Kg/day with at least half of the PRO of high biological value.
What amount of energy, phosphorus, sodium, potassium, and calcium is generally recommended for clients with pre-ESRD?
- Energy- Calories to maintain wt
- Phosphorus- Limited to <1000mg/day. May require a phosphate binder
- Sodium- Individualized OR 1-3g/day
- Potassium- Individualized per lab values
- Calcium- Individualized per labs (Ca, PTH, and Phos) may need vit D
Which renal patients may require a fluid restriction?
Pt c edema, congestive heart failure, pt c ESRD renal pt c uncontrolled hypertension
Identify fluid inputs and outputs.
- Input: Water pt is drinking and/or ice chips, beverages, foods-soup, ice cream, Popsicle
- Output: Urine, stool, sweat & fever, vomit
In pt with chronic renal insufficiency, which hormone is no linger normally synthesized by the kidneys and may need to be given to clients to treat anemia and stimulate the formation of erythrocytes?
When the GFR falls below 20mL of blood per min, what concentration increases and what activation in the kidneys is inhibited?
Phosphorus concentration and vitamin D activation by the kidneys
What results in the decreased abs of dietary Ca, leading to a low blood Ca concentration?
Increased phosphorus concentration and inhibited vitamin D activation
What occurs when parathyroid hormone is secreted?
Increased blood calcium concentration by causing blood resorption. This leads to brittle bones and Ca depositions in soft tissues including the kidneys, causing yet more loss of renal function
What is the number one action to prevent renal osteodystrophy in clients with chronic renal insufficiency?
- Control phosphorus concentration by restricting dietary intake
- Phosphate binder medication with food
What vitamin supplementation is associated with toxicity in patients with chronic renal insufficiency?
What are the goals of MNT for adult clients with nephrotic syndrome who are not on dialysis?
- 1. Assist in meeting nutritional needs, replacing nutrients lost, maintain a good nutritional status
- 2. Reduce complications (edema, proteinuria, hyperlipidemia)
- 3. Help slow the progression of renal disease and prevent the development of atherosclerosis and CVD
What are the dietary recommendations for adult clients with nephrotic syndrome who are not on dialysis?
- Energy- 35kcals/kg/day
- PRO- .8-1.0g/kg/day
- Fat- <30% total kcal
- Cholesterol- <200mg/day
- Sodium/Fluid- <2000mg/day; fluids generally not restricted
- V/M- Zinc, Iron, Ca, and Vit D if proven deficient
Kidney's activate what vitamin?
What is the main waste product of AA catabolism?
What are the 2 most common caused of chronic kidney disease?
Hypertension and DM
Is the creatinine height index a useful tool to estimate muscle mass and protein-energy nutritional status in clients with pre-end-stage renal disease or end-stage renal disease? Why or why not?
Not with renal disease, creatinine show kidney c/n excrete it
Do high-protein diets cause renal failure? Explain.
No, however someone c renal failure should not have more than .8g/kg/day to slow progression of disease
One of your renal clients on a fluid restriction is suffering from thirst. Give 10 practical tips to help him control his fluid intake and reduce his thirst.
- 1. Switch water in mouth
- 2. Pitcher of water to visually see amt daily
- 3. Hard candies
- 4. Ice cubs (last longer)
- 5. Smaller glass to drink out of
- 6. Drink slowly
- 7. Dont use it for meds, soft foods
- 8. Lemon juice decreases thirst
- 9. Decrease intake of salty foods
- 10. Juicy foods (peaches, pears)
A low protein, low phosphorus diet is recommended for clients with pre-ESRD for the following reasons:
To prevent/limit waste products and reduce N build-up. High phosphate concentration lead to Ca loss
In a catabolic client, cell breakdown releases ________, which increases in the blood.
High serum ____________ concentration makes clients fell very itchy and caused muscle spasms.
Low serum _____ concentration is the biggest predictor of morbidity and mortality in clients with renal disease.
Which abnormal biochemical test values are typically seen in clients with nephrotic syndrome?
- Decreased Albumin
- Increased Lipids
- Increased PRO in urine
Which drug may help reduce protein loss in urine in clients with nephrotic syndrome?
What is the only cure for clients with end-stage renal failure?
In clients using continuous ambulatory peritoneal dialysis, what serves as a natural dialyzing membrane?
What is oliguric?
Less than 500 mL urine/day
What is Azotemia?
Accumulation of N containing waste products in blood
What is renal function?
Ability to eliminate nitrogenous waste products
What is renal failure?
Inability to excrete the daily load of these wastes
What is nephrotic syndrome?
Deficiency of albumin in blood and its excretion in the urine d/t altered glomerular function-large-molecule proteins and RBCs "leak" into urine. Proteinua >3.5 Hypoalbuminemia- low blood albumin
Why do nephrotic syndrome pt have hyperlipidemia?
Elevated blood lipids since they cannot make lipoprotein lipase. Therefore, lipids stay in blood.
What are the clinical manifestations of nephrotic syndrome?
- Frothy Urine
- Anorexia, malaise, puffy eyelids, abd pain, muscle wasting
- Altered blood pressure
- Loss of zinc, copper, vitamin D; iron bound to PRO lost
What is Chronic Renal Failure?
- Syndrome in which progressive loss of kidney functions occurs
- Not reversible
- Progression to ESRD
- Renal replacement therapy or tansplant
- Requires meds and specialized diet
What are ways to slow the progression CKD?
- Control DM
- Keep BP at healthy level
- maintain wt
- healthy diet
What are the common complications of CKD?
- Bone and mineral disorders (cant activate vit D)
- Anemia (Cant produce RBC)
What are the 3 phases of management?
- Phase 1: Conservative management using diet and drugs
- Phase 2: Use of dialysis
- Phase 3: Kidney Transplant
What is renal replacement therapy?
Dialysis- Removal of excessive and toxic by-products of metabolism from the blood, replacing the filtering function of the kidney
What is high biological PRO?
What are the nutritional recommendations for acute renal failure?
- Energy and PRO
- May need enteral nutrition
- Protein .6 to 1.4 g/kg/d; essential and nonessential AA
- Kcal 30-35 kcal/kg/d
- 60% CHO, 20-35% fat