Renal Disease

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Renal Disease
2012-04-03 22:43:25

Renal Disease
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  1. What is the unit of kidney structure and function
    the nephron
  2. What are the main functions of the kidneys?
    • Fulid balance (electrolytes too)
    • Production of erythropoeitin
    • Activates vitamin D for Ca absorption
    • Makes renin (angiotensin I --> II)
  3. What is creatinine and how is it excreted?
    • A nitrogen containing substance derived from creatin phosphate
    • Produced by muscles appears in teh blood and is excreted into the urine by the kidneys
  4. How does the body catabolize the nitrogen group of A.A?
    • Through deamination into ammonia by the liver
    • Ammonia is degraded throught the urea cycle in the liver
  5. What is the active form of vit D and where is it activated?
    • 1, 25- dihydroxy vitamin D3
    • kidneys
  6. What is the separation of molecules in solution by diffusion through a selectively permeable membrane on the basis of molecule size and concentration gradient?
  7. In a healthy individual, the 24-hour urinary excretion of _______ is preportionate to the skeletal muscle mass of the individual. It can therfore be used as a tool to help estimate body protein status
  8. Foods containing phosphorus
    milk, pork, lentils, chocolate, yogurt, cottage cheese, basked potatoes
  9. Foods containing potassium:
    baked potatoes, avocado, orange, banana, potato chip
  10. What is the accumulation of excess body fluids in cells, tissues, or several cavities, often causing swelling of extremities, such as hands, feet, legs and face?
  11. ______ is the most abundant intracellular cation?
  12. Why is high blood potassium concentration considered to be a dangerous state?
    high blood K+ concentration causes stress on the heart and can cause arrhythmias and heat attacks
  13. How are the fluid needs of healthy adults estimated?
    • 1 mL per Kcal
    • 35 mL/Kg
  14. _____ is the branch of medicine studying kidney anatomy, physiology and pathology
  15. _____ are specialists of the kidneys, their diseases, and medical management
  16. ______ is the general term referring to an abnormal conditon of the kidneys due to disease
  17. ______ is kidnet inflammation, which an be acute or chronic
  18. _______ is when the renal tissue is hardened with reduced blood flow. It is often cause by hypertension
  19. ______ is an abnormal kidney condition causing clinical signs of edema, marked porteinuria, low blood albumin conc., and hyperlipidemia due to increased glomerular permeability as a result of glomerular injury
    nephrotic syndrome
  20. ______ is a clinical state of severe glomerulonephritis with blood in urine, high blood pressure, and kidney failure (losing rbc in urine)
    nephritic syndrome
  21. ______ qualifies a state of excess urea in blood
  22. _______ is an abnormally high amount of protein in urine
  23. ________ is the abnormal presence of albumin in the urine
  24. _____ is the abnormal presence of blood or erythrocytes in the urine
  25. _____ means high blood sodium concentration
  26. ______ means high blood potassium concentration
  27. The _____ is the liquid collected after dialysis taht went through the selectively permeable membrane
  28. The kidneys are responsible for maintaining blood pH at:
  29. Which clients are susceptible to developing acture renal failure?
    • intensive care patients with multiple organ failures
    • trauma
    • burn victims
    • sepsis
  30. What metabolic abnormalities are seen in clients with acute renal failure?
    • reduced urine production (oliguria, anuria)
    • blood electrolyte abnormalities (high blood K+, and P-)
    • abnormal fluid status (edema)
    • acidosis
    • hyperglycemia
    • elevated blood urea
  31. What type of diet is recommended for clients with acute renal failture?
    • proetin restriction (0.6-0.8)
    • (Although those on dialysis require high protein (1.2-1.5) for HD and (1/5-2.0 g/kg) for continuour renal replacement patients)
  32. What factors should you keep in mind when making nutirional recommendations for clients with acute renal failure?
    • clients are very ill at first adn may not be able to eat (due to N&V)
    • the presence/degree of body protein catabolism in the client
    • the degree of clinical stress
    • the nutritional status of client
  33. Explain the 5 stages of the development of CKD
    • 1. There is damage to teh kidney's which causes proteinuria, but the GFR is still normal (or slightly elevated)
    • 2. Kidney damage progesses and GFR is mildly decreased (60-89 mL/min)
    • 3. The GFR is moderately decreased to 30-59 mL/min
    • 4. The GFR falls below 30 mL/min (15-29)
    • 5. ESRD, the GFR is <15 mL/min, which characterizes kidney failure (dialysis or transplantation is required)
  34. What are metabolic and clinical consequences of CKD?
    The kidneys become progressively less and less able to perform their normal physiological functions, including removing waste products from blood (urea/creatinine)
  35. Symptoms caused by increased levels of urea in the blood/uremic symptoms?
    • weakness
    • itchy skin
    • N&V
    • fatigue
    • muscle cramping
    • anorexia
    • irritability
  36. What are two main goals of nutrition management for clients with pre-ESRD?
    • To help clients meet their nutirtional needs and maintian a good nutritional status
    • To provide nutrition education/counseling to help slow the progression of renal insufficiency, which will assist in preventing/maintaining metabolic complications
  37. Diet recommendations for pre-ESRD
    • reduced in Pro, P, Na
    • may also need to be controlled in K, fluids, and energy to meet their individualized needs
    • energy should allow maintanence of a healthy body weight
  38. What level of dietary protein restriction is usually required for clients with pre-ESRD
    • (0.6-0.8 g/kg)
    • GFR 25-55 (0.75-0.8)
    • GFR <25 (0.6)
  39. Recommmendations of Kcal, P, Na, Ca for clients wtih pre-ESRD
    • Energy: 35 kcal/kg (<60) and slightly less for older adults [if overweight: 20-30 kcal/kg; underweight: 45 kcal/kg]
    • Phosphorus: restricted to 0.8-1 g when serum P or PTH concentrations are elevated
    • Sodium: 1.0-3.0 g (~2g)
    • Potassium: not usually restricted, however K is based on individual serum K concentration, serum K is restricted when serum K is high and urin output is <1.1 qt)
    • Calcium: 1000-1500 mg (~1200mg) [no more than 2000 mg daily with phosphate binders]
  40. When the GFR falls below 20 mL of blood per minute, blood_____ concentration increases, which inihibits vitamin ___ activation by the kidneys
    phosphorus; D
  41. The brain reacts by stimulating the secretion of ___ hormone, which increases blood Ca concentration by causing bone resorption. However, this leads to brittle bones and calcium depositions in soft tissues, causing more loss of renal function
  42. the number one action to prevent renal osteodystrophy in clinets with chorinc renal insufficiency is to control blood ___ concentrations by restriciting dietary P and asking clients to take their ____ binder medication with food
    phosphorus; phosphate
  43. Vitamin ___ supplementation is associated with toxicity in patients with chronic renal insufficiency
  44. What are the goals of MNT for adult clients wtih NS who are not on dialysis
    • to assist clients in meeting their nutiritonal needs, replacing nutrientes lost, and maintaining a good nutritional status
    • to help reduce the metabolic complications of NS, including edema, proteinuria, and hyperlipidiemia and promote normalizing biochemical test values
  45. Kidneys are important for the activation of vitamin ___
  46. What is the main waste product of A.A catabolism
  47. the two most common causes of CKD are:
    hypertension and DM
  48. Is the creatining height index useful to estimate muscle mass and protein-energy nutritional status in clients with pre-ESRD or ESRD
    no, they aren't excreting creatinine, not useable for malnutiriton with renal patients
  49. Do high-Pro diets cause CRF
    no, there is no evidence
  50. Tops to control fluid intake
    • limit high salt foods
    • drink from small glasses
    • drink only when thirsty
    • swish water/fluid around in mouth
    • use sour-candies or sugar free gum
    • place allowed amount of water in pitcher and each time you drink, empty out the amount drank from pitcher (visual aid)
  51. A low-Pro, low-phosphorus diet is recommended for clients with pre-ESRD for the following reasons:
    • prevent uremia (decreases nutrogenous waste build-up_
    • slow development of renal disease
    • prevent complications/ renal dystrophy
  52. Parathyroid hormone
    • increases calcium reabsorption by the kidneys
    • increases calcitriol prodiuction by the kidneys
    • it decreases kidney reabsorption of phosphorus
    • its production decreases in response to an increase in serum Ca
  53. ____: less tha 500 mL urine/d
  54. _____: accumulation of nitrogen containing waste products in blood
  55. ____: ability to eliminate nitrogenous waste products
    renal function
  56. _____: inability to excrete the daily load of theses wastes
    renal failure
  57. Treatment for NS
    • treat underlying cause
    • reduce protein in urine
    • control b.p
    • check K levels
  58. MNT for NS:
    • control Pro (0.8-1.0 g/kg/d)
    • energy: 35 kcal/kg
    • fat: <30%
    • Na: <2g
  59. Syndrome in which progressive loss of kidney function occurs
    (progression to ESRD)
  60. Common complications with CKD
    • malnutrition
    • bone/mineral disorders (renal osteodystrophy)
    • anemia
    • (dialysis removes creatinine/urea, but also H20 soluble vitamins
  61. Treatment of CKD
    • treat underlying disease, delay progression
    • Stages 1+2: EPO replacement, vit D supplementation
    • Stage 5: renal replacement therapy, MNT is crucial (possible transplantation)
  62. General objectives of MNT for CKD
    • maintain optimal quality of life
    • minimize risks of renal osteodystrophy
    • reduce/prevent/slow progression of failure
    • delay necessitiy for dialysis
  63. Phases of management for CKD
    • phase 1: diet/drugs
    • phase 2: use of dialysis
    • phase 3: transplant
  64. Renal replaement therapy (dialysis)
    removal of excessive and toxic by-products of metaboilsm from the blood, replacing the filtering function of the kidney
  65. Hemodialysis (HD)
    • membrane is manmade dialyzer- "artificial kidney"
    • 3 d/wk for 4 hrs/Tx
  66. Peritoneal dialysis (PD)
    • lining of patients peritoneal wall is the selective membrane
    • (CAPD, CCPD, NIPD)
  67. Diet assessment for CKD
    • fluid and electrolytes
    • Fat, CHO, and Kcals
    • Pro, H/L biological value
    • salt subsititues (check levels of K)
    • Vitamin and mineral supplement
  68. serum creatinine
    muscle mass related (not diet)
  69. Blood urea nitrogen
    diet related