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Main Kidney Functions

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Maintain body's fluid and electrolyte to balance, maintain body's acid base balance, maintain water balance, eliminate metabolic wastes (vitamin D and B) regulate blood pressure, produce hormone (erythropoetin) that stimulates red blood cells in bone marrow can lead to anemia, convert vitamin D into most active form

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Nephron

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Functional unit of kidney

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Glomerulus

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Located in nephron (gate to enter nephron)

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Filtrate

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Passes through tubule, some components return to body while some excreted in urine

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Renal Disease Causes

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Inflammatory and degenerative disease, infection and obstruction, damage from other diseases, damage from other agents like medications like Tylenol and Advil

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Renal Disease States

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Nephrotic Syndrome,Acute Kidney Injury (Acute Renal Failure), Chronic Renal Failure

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Nephrotic Syndrome

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Kidney disorder characterized by urinary protein losses (proteinuria) exceeding 3.5g/day

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Nephrotic Syndrome Symptoms

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Low serum albumin (albuminuria), elevated blood lipids, low urine output (oliguria) and edema, weakness,manorexis, headaches

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Proteinuria

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Loss of protein in urine

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Albuminuria

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Loss of albumin in urine

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Nephrotic Syndrome

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Glomerular permeability increases, blood plasma proteins spill into urine, plasma protein levels decrease

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Result of Decreased plasma protein levels

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Lean body tissues break down, albumin decreases, immunoglobulins decrease, vitamin D binding protein lost, blood clearance of lipids decrease

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Result of Decreased blood clearance of lipids

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Wasting, edema, infection, rickets, altered blood lipids

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Nephrotic Syndrome Treatment Goal

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Relieve symptoms and prevent kidney damage

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Nephrotic Syndrome Treatment

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Underlying disorder should be corrected

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Medications for Nephrotic Syndrome

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Anti-inflammatory drigs, ACE inhibitors, diuretics, anti-hypertensives, immunosuppressants, lipid-lowering medications

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Medical Nutrition Therapy for Nephrotic Syndrome

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Kcalorie controlled: 35 kcal/kg/day, protein comtrolled: 0.8-1.0 g/kg/day, fat controlled: diet low in saturated fat, cholesterol and refined sugars, sodium: 1-2 g/day

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Medical Nutrition Therapy for Nephrotic Syndrome

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Potassium: if diuretics prescribed for edema it may cause potassium wasting; patients encouraged to select foods rich in potassium, vitamins and minerals: may require vitamin D and calcium supplementation, multivitamins

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Acute Kidney Injury

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Sudden loss of kidneys ability to function

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Acute Kidney Injury Disease Process

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Burns, tissue destruction, infectious disease, shock/surgery, toxic agents, immunologic drug reaction

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Acute Kidney Injury Consequences

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Fluid and electrolyte imbalance, oliguria, hyperkalemia, hyperphosphatemia, uremia

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Oliguria

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Production of <400 mL urine/day

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Average Urine Output for Adults

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0.5-1.0 mL/kg/hr

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Hyperkalemia

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Elevated serum potassium levels

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Hyperphosphatemia

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Elevated serum phosphate levels

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Uremia

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Accumulation of nitrogen containing waste products in blood

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Result of Uremia

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Lethargy, fatigue, confusion, headache, anorexia, nausea, vomiting, diarrhea, metallic taste in mouth

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Acute Kidney Injury Treatment

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Drug therapy and dialysis

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Diet Therapy for Acute Kidney Injury

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Diuretics andpotassium-exchange resins

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Dialysis for Acute Kidney Injury

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Procedure for removing wastes and excess fluid from blood after kidneys have stopped functioning

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Acute Kidney Injury Medical Nutrition Therapy

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Protein (no restriction), energy (HBE), electrolytes and fluid balance

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Protein for patients with limited kidney functions prior to AKI who aren't treated with dialysis

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0.6-0.8 g/kg/day

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Protein for patients whose kidney function improves or treatment included dialysis

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1.2-1.3 g/kg/day

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Electrolytes and Fluid Balance

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Maintain fluid balance, monitor calcium, K, P, Mg, Na

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Chronic Renal Failure (Chronic Kidney Disease)

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Gradual and irreversible deterioration of kidney function

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Chronic Renal Failure

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Before Acute Kidney Injury = protein restriction

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Chronic Renal Failure Causes

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Diabetes, hypertension, inflammatory diseases, immunological doseases, hereditary diseases, renal insufficiency, end stage renal disease, glomerular filtration rate, blood urea nitrogen, dialysis/kidney transplant needed

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Renal Insufficiency

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Renal function decrease but not life threatening

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Glomerular Filtration Rate (GFR)

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Falls to <15 mL/minute; healthy GFR = <90

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Hematuria

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Blood in urine

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Blood Urea Nitrogen (BUN)

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May increase as high as 150-250 mg/dl

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Chronic Renal Failure Symptoms

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Altered electrolytes and hormones, sodium loss, potassium not impaired until oliguria, calcium and P distributed, protein energy malnutrition

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Chronic Renal Failure Early Stages

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Anorexia, fatigue, headache, hypertension, itching, kidney inflammation, nephrotic syndrome, nausea, vomiting, proteinuria, Hematuria

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Chronic Renal Failure Advanced Stages

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Anemia, bleeding tendency, cardiovascular disease, confusion, mental impairment, electrolyte abnormalities, fluid retention, metabolic acidosis, peripheral neuropathy, protein energy malnutrition, decrease immunity, renal osteodystrohpy

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Uremic Syndrome

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Cluster of symptoms and complications that develops during final stages of chronic renal failure

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Uremic Syndrome

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GFR <15 mL/minute, BUN exceeds 60 mg/dL, anemia, bone disease, hormonal imbalance, bleeding impairment, increase risk of cardiovascular disease, decreased immunity

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Chronic Renal Failure Treatment Goal

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Slow disease progression and alleviate symptoms

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Chronic Renal Failure Treatment

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Drug therapy and dialysis

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Drug Therapy for Chronic Renal Failure

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Anti-hypertensives, erythropoetin, phosphate binders (taken with food), sodium bicarbonate, cholesterol-lowering meds, vitamin D supplementation

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Chronic Renal Failure Medical Nutrition Therapy

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Energy, protein, lipids, fluids and sodium, potassium, calcium, phosphorus, vitamin D, vitamins and minerals, enteral/parenteral nutrition, dietary compliance

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Dietary Recommendations for Chronic Renal Failure include

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Energy, protein, fluid, potassium and phosphorus

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Energy Recommendations for Chronic Renal Failure Predialysis, Hemodialysis and Peritoneal Dialysis

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60 years: 30-35 kcal/kg

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Protein Recommendations for Chronic Renal Failure Predialysis

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0.6-0.75 g/kg (>50% high quality protein)

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Protein Recommendations for Chronic Renal Failure Hemodialysis

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>1.2 g/kg

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Protein Recommendations for Chronic Renal Failure Peritoneal Dialysis

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>1.2-1.3g/kg

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Fluid Recommendations for Chronic Renal Failure Predialysis

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Unrestricted if urine output is normal

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Fluid Recommendations for Chronic Renal Failure Hemodialysis

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500-1000 mL/day+ daily urine output

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Fluid Recommendations for Chronic Renal Failure Peritoneal Dialysis

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As necessary to maintain fluid balance

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Potassium Recommendations for Chronic Renal Failure Predialysis

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Unrestricted unless hyperkalemia present

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Potassium Recommendations for Chronic Renal Failure Hemodialysis

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2000-3000 mg/day; adjust according to serum potassium levels

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Potassium Recommendations for Chronic Renal Failure Peritoneal Dialysis

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3000-4000 mg/day ; adjust according to serum potassium levels

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Phosphorus Recommendations for Chronic Renal Failure Predialysis, hemodialysis and peritoneal dialysis

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800-1000 mg/day if serum phosphorus/parathyroid hormone is elevated

Renal Disease Diet Modifications – Flashcards

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