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Diet therapy 4.14 Kidney Disease Essay

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Urinary excretion is the primary methods by which the body rida it’s self of……..
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1. excess water 2. electrolytes 3. organic acids 4. drugs 5. nitrogenous wastes sulfates 6. toxic substances
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The kidneys help to regulate acid-base balance in the body by……
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secreting hydrogen ions to increase pH and excreting bicarbonate to lower pH.
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Kidney’s also regulate…
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1. blood pressure 2. the metabolism of calcium and phosphorus
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General cause of Renal disease
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1. infection 2. degenerative changes 3. diabetes mellitus 4. CV disorders 5. Cysts 6. Renal stones 7. Trauma—(burns, injury, poisons, surgery)
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Nephrotic Syndrome
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a generic term that refer to a kidney disorder characterized by urinary protein losses greater than 3.5g/day
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Major symptoms of Nephrotic Syndrome
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Proteinuria Hyperlipidemia
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Proteinuria
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Protein in the urine; also known as albuminuria
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Hyperlipidemia
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Abnormally high levels of lipids in the blood, such as “LDL” cholesterol & Triglycerides
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Hypoalbuminemia & Proteinuria may lead to–
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protein-calorie malnutrition, anemia, increased risk of infection, vitamin D deficiency, and increased clotting.
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Hyperlipidemia
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increases the risk of cardiovascular disease and progressive renal damage.
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Causes of Nephrotic Syndrome
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-Diabetes -autoimmune disease (lupus, E.G, IgA, nephropathy) -infections -certain chemicals -medications
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Nephrotic syndrome *nutritional therapy*
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*Goals* -to minimize edema, proteinuria, and hyperlipidemia -to replace nutrients lost in the urine -to reduce the risk of progressive renal damage and atherosclerosis
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Treating Nephrotic Syndrome and underlying causes
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-in some cases treating the underlying disorders corrects nephrotic syndrome -in other cases, especially diabetes, nephrotic syndrome may be the beginning of *chronic kidney disease*
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Benefits of minimizing Proteinuria
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To prevent complications, protect kidney functions, reduce the risk of atherosclerosis, and maintain good nutritional status
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Why would a protein sparing diet be ordered?
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A high protein diet is contraindicated because it exacerbates urinary protein losses, promoting further kidney damage.
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Sodium and restrictions are for
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to help control edema; fluid restrictions is generally not necessary
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Sodium and fluid restriction begins:
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(for stages 1-4 and hemodialysis) with decreased out put -1000 to 3000 mg/day are recommended -*range* is 2000 to 4000 mg for peritoneal dialysis
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Fluid unrestricted in stages 1-4 with normal output for…
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people on hemodialysis, fluid allowance equals the volume to any urine produced plus 1000ml
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Phosphorus and calcium with Nephrotic syndrome
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-as kidney function deteriorates, the conversion of Vitamin D to it’s active form is impaired *in stages 1-4* Phosphorus allowance is based on lab values and calcium is limited to 1000-15000 mg/day *Phosphate Binders* must be taken with all meals and snaks
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Chronic Kidney Disease
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*develops slowly* is characterized by a gradual decline in renal function related to progressive irreversible nephron damage. -loses the ability to filter blood
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Losing the ability to filter blood will cause
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Uremia to occur: if you have (Uremia) your kidneys are not clearing out the waste. *if severe, can result in death unless dialysis in begun or kidney transplant is performed*
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Chronic Kidney disease & the impaction on nutrition
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*loss of kidney function produces widespread effects* -as urine output decreases, fluid and electrolyte accumulates in the blood, producing symptoms of overhydration such as increased blood pressure, weight gain edema, shortness of breath and lung crackles. -Uremic syndrome -acidosis occurs
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Modifiable Risk factors for Chronic kidney disease
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1. smoking cessation, an increase in physical activity, and controlling blood lipid levels 2. Stage 5 requires dialysis or kidney transplant for survival 3. Diabetes and hypertension are the leading cause of CKD. 4. Other Risk factors include cardiovascular disease, obesity, hypercholesterolemia, and family hx of CKD
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Chronic kidney Disease impairs reabsorption of
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-some nutrients -Gi absorption of some minerals, such as calcium and iron is impaired -Impaired synthesis of renin, erythropoietin, and active form of Vitamin D can lead to high blood pressure, anemia, and bone demineralization -accelerated atherosclerosis increases the risk of coronary heart disease, myocardial infarction, and further renal damage
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Chronic Kidney Disease & nutritional therapy Goals- individualized to
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-prevent protein catabolism -maintain water balance -correct acidosis -control fluid and electrolyte loss -maintain optimal nutritional status -control complications -retard progression of renal failure
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Catabolism
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is the breaking down of protein to amino acids
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Pre Dialysis Diet
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Protein will be down with more calories
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During Dialysis Diet
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More protein and less calories
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Chronic Kidney disease Nutritional Therapy
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*Goals* -reduce workload on the kidneys -restore or maintain optimal nutritional status -control the accumulation of uremic toxins -Diet is both complex and dynamic
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Diet modifications are made for
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-responses and laboratory values and require frequent monitoring and adjustments
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Chronic Kidney disease *protein*
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– as kidney function declines, the ability to excrete nitrogenous and other wastes also declines -HBV proteins are stressed because they provide a higher percentage of essential amino acids which minimize urea production.
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Diet modification of renal disease (MDRD)
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-study show that tight control of blood pressure and restricted protein intake of (0.3 to 0.6g/kg/day) helped delay the progression of kidney disease
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Protein allowance in stage 5 is
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50% higher than that RDA to account for the loss of seum proteins and amino acids in the dialysate
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Chronic Kidney Disease & Calories
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-when protein intake is restricted, it is vital to consume adequate calories to spare protein from being used for energy, enabling it to be used for protein synthesis
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for all stages of CDK with calories
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*calorie recommendations are 35 cal/kg for adults younger than 60 years of age *35 cal/kg for those who are older
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During Peritoneal dialysis & calories
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a large amount of calories is absorbed daily through the dialysate (approximately 340-680 cal/day) -Calories from the dialysate impair the natural sense of hunger and generally prevent a fall in blood glucose levels between meals *increased intake of pure sugars and pure fats helps to meet calorie requirements while keeping protein intake low*
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Sodium and fluid with CKD
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intake is monitored by weight -for many patients on hemodialysis, fluid restriction is the hardest because it can dehydrate you
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Potassium with CKD
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-loss of kidney function means potassium is impaired and hyperkalemia is a RISK. (at all CKD stages, potassiu allowance is based on the individual’s serum potassium levels)
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HypoKalemia is a risk for people
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who receive continuous ambulatory peritoneal dialysis, take potassium-wasting diuretics, or who experience vomiting or diarrhea
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Phosphorus & CKD
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CKD progression leads to a gradual decline in phosphorus excretion, resulting in hyperphophatemia, hypocalcemia, and low levels of activie vitamin D stimulate PTH (secretion, creating secondary hyperparathyroidism) -correcting and preenting hyperphosphatemia is a major component of CKD
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PTH is
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Parathyroid Hormone
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Hyperphosphatemia
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pulls calcium out of the bones when the PTH is too active
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Vitamins & minerals with CKD
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pt’s will have to have -specially formulated vitamins supplements -deficiencies of water-soluble vits -fat-soluble vits A and E have been shown to accumulate in CKD -pt’s who are undergoing dialysis may develop a deficiency of zinc -IV iron for pt’s receiving hemodialysis
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Nutrition during Dialysis CKD
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protein: 50% higher than RDA, varies with dialysis type Protein restrictions: 800-1000mg Calorie recommendations: 35cal/kg for adults under 60; 30-35 cal/kg over 60 H2O: limited to 400-500 ml/day and amount of output (esp hemodialysis)
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Diet for CKD is comples
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“choice” -system similar to the diabetic exchange system, may be used to help pt’s implement dietary restrictions -individualized meal -selections can be severely limited
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Kidney transplant
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-a treatment option for people with ESRD -immediate postoperative diet is high in protein and calories to promote healing -most dietary parameters are removed when the new kidney functions normally. -lifelong commitments to “healthy” eating is important -*immunosuppressants taken for life*
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Acute Kidney injury
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is the sudden loss of renal function characterized by an acute increase in serum creatinine and decrease in urine output* -can develop over a period of hrs to days -can range from mild to severe -primary focus of treatment is to correct the underlying disorder
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AKI causes
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shock severe infection trauma medications obstructions
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Acute Kidney Injury nutritional therapy
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-it has NOT been proven that nutrition therapy for AKI promotes recovery of kidney function or improves survival *Goal is to provide adequate amounts of calories, protein, and other nutrients to prevent or minimize malnutrition* -it is difficult to achieve nutritional goals with oral, enteral, or parenteral nutrition -one approach is to strictly *LIMIT FLUID, ELECTROLYTES, AND PROTEIN* -for patients who are malnourished and hypercatabolic, the approach may be to give ample amounts of protein and nutrients and provide dialysis as needed
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Kidney stones
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*form when insoluble crystals precipitate out of urine* -appox 75% of kidney stones are made of CALCIUM) -High fluid intake dilutes the urine (can also cause urinary tract infections)
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Risk factors for Kidney Stones
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-dehydrations or low urine volume, urinary tract obstructions, gout, chronic inflammation of the bowel, and intestinal bypass or ostomy surgery
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Uric Acid
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Purine rich foods are restricted, usually associated with gout, GI disease, & malignant disease *purines: are found in all meat and fish and poultry* (causes kidney stones)
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Struvite
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magnesium ammonium phosphate crystals formed by the action of bacterial encymes (causes kidney stones)
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Oxalate
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a salt of oxalac acid, can form stron bond with various minerals when combined with calcium (it forms a nearly insoluble compound)
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Dietary factors that either promote or inhibit the formation of calcium oxalate kidney stones
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*fluid* -low fluid intake: increases the chances of stones -adequate fluid intake: will decrease the formation of stones *oxalate* -found in plant foods -normally only 2%-15% consumed is absorbed -Hyperoxaluria: elevated levels of oxalate in urine levels will cause the formation of stones
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Calcium & stones
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binds with dietary oxalate in the intestines, forming an insoluble compound that the body cannot absorb -normal Ca intake consumed throughout the day is recommended to decrease the risk of stone formation, this can be obtained by consuming Ca in food and avoiding Ca supplements.
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Protein & stones
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High intake of animal protein increase urinary excretion of calcium, oxalate ,and uric acid and reduces urinary pH
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Sodium & stones
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A high sodium intake promotes urinary calcium excretion by decreasing calcium reabsorption by the kidneys
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Nutritional therapy for stones
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none of the diet recommendations made to prevent kidney stones are effective when used alone! -nutritional therapy is considered the cornerstone in kidney stone management, with or without medications
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Dash Diet for kidney stones
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-high in fruits and vegitables -moderate to low-fat dairy products -relatively low in animal protein
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Patient education
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-essential to help client understand affect and nutritional needs -renal disease is lifelong challenge with potential anger and depression making them less receptive to teaching and dietary changes -nurse should establish a trusting relationship with sincere understanding and sympathy for pt’s complaints, concerns, and needs- can help to motivate patients