CKD Flashcards by EMG G

How many L of fluid of ultrafiltrate is produced in filtering this blood and through active process of reabsorbing certain components and excreting others

180 L of fluid of ultrafiltrate

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L of urine excreted in an average per day.

1.5 L of urine

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The kidney can get rid of as little as ____ of concentrated urine or as much as ___.

500ml

12 L.

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Urinary volume of <500 ml/day is called

oliguria.

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Solute Load consists of

Nitrogenous wastes & Electrolytes

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Nitrogenous wastes consists of

Urea
Uric acid
Creatinine
Ammonia

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Electrolytes

Na
K
Cl

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Renal Diseases that needs protein restriction

Glomerular disease
Acute Renal Failure
Chronic Kidney Disease

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What are the 2 types of Glomerular Disease?

Nephritic Syndrome (uremic)
Nephrotic Syndrome

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What is Nephritic Syndrome?

The syndrome of hematuria, hypertension, and mild loss of renal function that results from acute inflammation of the capillary loops of the glomerulus.

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Medical Nutrition Therapy for Nephritic Syndrome

Sodium restriction - HPN

- Restricting protein or potassium intake is of no benefit unless significant uremia or hyperkalemia develops

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A condition resulting from loss of the glomerular barrier to protein, characterized by massive edema, proteinuria, hypoalbuminemia, hypercholesterolemia, hypercoagubility, and abnormal bone metabolism.

Nephrotic Syndrome

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Medical Nutrition Therapy for Nephrotic Syndrome

0.8 gm/kg/day can decrease proteinuria without adversely affecting serum albumin.

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% of HBV for protein optimal use for nephrotic syndrome

75% HBV

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Kcal for adult and children for nephrotic syndrome

35 kcal/kg/day for adults

100-150 kcal/kg/day for children

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Sodium allowance for nephrotic syndrome

Sodium – 3 gm/day

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CKD structural criteria

Kidney damage for > 3 months

albuminuria is the most common marker of kidney damage and is associated with rapid progression

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CKD Functional criteria

GFR < 60 mL/min per 1.73m2 for > 3 months

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Normal GFR

125 mL/min

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GFR (M)

weight (kg) x 140 – age/

72 x serum creatinine (mg/dl)

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GFR (W)

weight (kg) x 140 – age X 0.85/

72 x serum creatinine (mg/dl)

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Stage 1 Serum creatinine of AKI

1.5–1.9 times baseline or > 0.3 mg/dl (>26.5 mmol/l) increase

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Stage 1 Urine output of AKI

<0.5ml/kg/h for 6-12 hours

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Stage 2 Serum creatinine of AKI

2.0–2.9 times baseline

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Stage 2 Urine output of AKI

<0.5 ml/kg/h for >12 hours

Stage 3 Serum creatinine of AKI

3.0 times baseline or Increase in serum creatinine to > 4.0 mg/dl (> 353.6 umol/l) Initiation of renal replacement therapy

Stage 3 Urine output of AKI

<0.3ml/kg/h for > 24 hours or Anuria for > 12 hours

Treatment of AKI

1. Replace renal function if warranted 2. Create a space for all the fluids that will be given to the patient. 3. Protein requirement 4. Calorie requirement

1. Replace renal function if warranted | Absolute Indications:

Intractable Hyperkalemia Intractable Fluid Overload Intractable Metabolic Acidosis Uremic Manifestations

AKI Protein requirement

should not be less than 0.8 g/kg/day.

AKI Protein requirement if ptx is catabolic

1.2 g to 1.5 g protein (or amino acids)/kg/day in patients with AKI who are catabolic.

AKI Calorie requirement

20 to 30 kcal/kg/day; even when they are in a hypermetabolic state because of other underlying diseases (i.e. sepsis or multiple organ failure), should not exceed 30 kcal/kg/day in any patient with AKI.

Normal adult urine output

1 to 1.5L/day

Anuria

<100ml or urine output per day

Oliguria

100 to 400 ml of urine output per day

Polyuria

>3L of urine output per day

It is characterized by the failure of kidney function to return to normal after acute kidney failure due to renal disease.

Chronic Renal Failure

CRF may be caused by:

glomerulonephritis, chronic infections(pyelonephritis), genetic defects, chronic hypertension and others.

is the most common treatment for kidney failure.

hemodialysis

is an artificial kidney designed to remove impurities from your blood.

A dialysis machine

CAPD

Continuous Ambulatory Peritoneal Dialysis

is done at home, usually 4 times every day. It takes less than 30 minutes each time and is a very simple, painless procedure. Because dialysis is carried out at home patients must be able and willing to take the major responsibility for their own care.

CAPD

MNT for hemodialysis

Less CHON is lost in HD than with peritoneal dialysis, nevertheless, amino acid losses still occur

Sodium content of 1/8 tsp salt

250 mg Na

Sodium content of ¼ tsp salt

500 mg Na

Sodium content of ½ tsp

1 gm Na

Sodium content of 1 tsp salt

2 gm Na

Sodium content of 1 tbsp salt

6 gm Na

an abnormality of kidney structure or function regardless of cause or specific clinical presentation and proposed a staging system based on the level of GFR.

CKD

The kidney receives __ % of cardiac output which allows the filtering of approximately __ L/day

20% | 1600 L/day of blood

If the label says Sodium free/salt free it means

<5mg Na per serving

If the label says Very low sodium it means

<35mg Na per serving

If the label says Low sodium it means

<140 mg Na per serving

If the label says Reduced sodium it means

At least 25% less Na than original product

If the label says Light in sodium it means

At least 50% less Na than original product

If the label says Unsalted/no added salt it means

No salt added during processing ( not salt-free)

Types of HYDRATION STATUS

Oncotic pressure | Osmotic pressure

the pressure at the capillary membrane due to dissolved proteins in the plasma & interstitial fluid

Oncotic pressure

the pressure at the cell membrane of the body fluids

Osmotic pressure

Dehydration – can result from:

- decreased H20 intake - excessive H20 output - heavy solute load

Edema – can result when there is:

- a decrease in plasma proteins | - a decrease in plasma oncotic pressure secondary to malnutrition & other causes

WHO CANNOT RECEIVE A TRANSPLANT:

- persons over 50 with poor health - history of CA - children below 20 kg BW

WHO CANNOT DONATE:

- siblings under 18 y/o

commonly associated with cyclosporine therapy warrants dietary K restriction, although this is only temporary.

Hyperkalemia

FRUITS HIGH IN K: | 1 med papaya

781 mg

FRUITS HIGH IN K: | ½ pureed avocado

729 mg

FRUITS HIGH IN K: | 1 slice watermelon

559 mg

FRUITS HIGH IN K: | 1 slice honeydew

461 mg

FRUITS HIGH IN K: | 1 medium banana

451 mg

are experienced by renal transplant patients caused by bone resorption associated with persistent hyperparathyroidism & effects of steroids on Ca, P & vitamin D metabolism.

Hypophosphatemia & mild hypercalcemia

FOODS RICH IN CALCIUM:

Milk Cheese Broccoli Soy milk Tofu Sesame seed Kale Yogurt

Majority of transplant recipients have elevated ____, ____, or _____.

serum triglycerides or cholesterol.

Intervention for transplant recipients consists of ____ ____ if overweight, cholesterol intake limited to _______ and ____ ____ ____.

calorie restriction 200mg/day Limited total fat

The most common disorders that affect the kidneys and urinary tract. Develop when stones constituents become concentrated in the urine and form crystals that grow.

KIDNEY STONES

Kidney stones is characterized by frequent occurrences between the ages ___ to ___ predominance in ____ (3X more often).

30 to 50, | males

are frequently associated with gout, Uric acid stones form when urine is supersaturated with undissolved uric acid, which occurs at urinary pH less than 5.5. Alkalinize urine with citrate or bicarbonate

Uric acid stones

Dietary Management for kidney stones

Diets restricted in Purine is prescribed to prevent uric acid stones The body synthesized cystine, NEAA from methionine;therefore patient with Cystine stones needs just enough methionine from the diet, and reduction of urine acidity is beneficial.

FOODS HIGH IN URIC ACID

``` Organ Meats Anchovies Sardines Meat-based broth Gravy ```

plays an important role in calcium stone formation.

Hyperoxaluria

The normal oxalate content is in the range of ___ to ___ mg/day & absorption does not usually exceed __% to __% of the amount in food.

80 to 100 mg/day | 10% to 20%

Oxalate cannot be metabolized in the body. | True or false.

True

renal route is the only mode of excretion of oxalate. | True or false.

True

FOODS HIGH IN OXALATE

``` Spinach 600-970 mg oxalate/100g Soy burger patty 870 mg oxalate/100g Almond 383 mg oxalate/100g Tofu 140-280 mg oxalate/100g Pecans 202 mg oxalate/100g Peanuts 187 mg oxalate/100g Okra 146 mg oxalate/100g Chocolate 117 mg oxalate/100g Sweet Potato 56 mg oxalate/100g ```

FOODS LOW IN OXALATE

``` Animal foods Avocado Cantaloupe Cauliflower Cucumber Lemon juice Melon Radish Squash ```

Dietary intake can influence the acidity or alkalinity of the urine. The acid-forming potential contributed by chloride, phosphorus & sulfur (anions) and the base-forming potential by sodium, potassium, calcium and magnesium (cations) True or false.

True

CKD Flashcards

(85 cards)