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Kidney Disease Interferes with

the normal capacity of nephrons to filter waste products of body metabolism

Short-term Kidney Disease requires

basic nutrition support for healing rather than dietary restriction.

The progressive degeneration of Chronic Kidney Disease requires

dialysis treatment and nutrient modification according to indivdual disease status

Current therapy for Kidney Stones depends more on

basic nutrition and health support for medical treatment than on major food and nutrient restrictions

Functions of the Kidneys

- Make urine, through which they excrete most of the waste products of metabolism
- Control the concentrations of most constituents of body fluids, especially blood.

Basic functional uint of the kidney

nephron

Major Nephron Functions

- Filtration of materials in blood
- Reabsorption of needed substances
- Secretion of hydrogen ions to maintain acid-base balance
- Excretion of waste materials

Additional Nephron Functions

- Renin secretion (for body water balance)
- Erythropoietin secretion (for red cell production)
- Vitamin D activation

Amount of nephrons _______ as you get older.

Decline
reason why kidney function declines

Glomerulus

- part of the kidney
- Cluster of branching capillaries
- Cup-shaped membrane at the head of each nephron forms the bowman's capsule
- Filters waste products from blood
- Glomerular filtration rate: Preferred method of monitoring kidney function.

Tubules

- Proximal tubule
- Loop of Henle
- Distal tubule
- Collecting tubule

Causes of Kidney Disease

- Infection and Obstruction
- Damage from other disease
* HTN, diabetes, cardiovascular disease, gomerulonephritis
- Toxins: Chemical pesticides, animal venom, nephrotoxic medications ( antibiotics, NSAIDS, contrast dyes)
- Genetic Defects: polycystic kidney disease, medullary cystic disease
- Sociodemographic factors
* old age > 60
* race (african americans, native americans, hispanics)
- Exposure to certain chemical and environmental conditions
- Low income or education

Most common cause of Kidney Disease in the U.S.

Diabetes

Clinical Factor Risks for Kidney Disease

- Poor glycemic control in diabetes
- Hypertension
- Malnutrition
- Autoimmune disease
- Systemic infections
- Urinary tract infections
- Urinary Stones
- Lower unriary tract obstruction
- Neoplasia
- Family history of chronic kidney disease
- Recovery from acute kidney failure
- Reduction in kidney mass
- Exposure to certain nephrotoxic drugs
- Low birth weight

Medical Nutrition Therapy for Kidney Disease

- Based on the nature of the disease process and individual responses
- Length of disease
- Degree of impaired renal function
- Individual clincal symptoms

Diet Therapy for Long term Kidney Disease

more specific nutrient modifications

Diet Therapy for Extensive Kidney Disease

Extensive nutrition therapy required

Symptoms of Glomerulonephritis

PROTEINURIA
HEMATURIA
-Edema
- Mild Hypertension
- Depressed appetite
- Possible oliguria, or anuria

Treatment of Uncomplicated Acute Golmerulonephritis

- antibiotics and bed rest

Treatment for Advanced Acute Glomerulonephritis

- Possible restriction of protein, sodium
- Liberal intake of carbs
- Potassium intake may be monitored
- Fluid intake may be restricted

Signs and Symptoms of Nephrotic Syndrome

MASSIVE EDEMA
Ascites
proteinurea
distended abdomen
reduced plasma protein level
body tissue wasting
HYPOALBUMINEMIA

Nutrition Therapy for Nephrotic Syndrome

- Protein intake to meet nutrition/growth needs (without excess)
- Carbohydrates given liberally
- Decrease Lipids
- Modest sodium restriction
- Potassium monitored and intake adjusted accordingly
- Water intake restricted according urine output

Acute Renal Failure

- Sudden shut down of kidneys in response to metabolic insult (infectious disease, toxic agents, drug reactions) or traumatic injury
- Medical Emergency
- Can last days to weeks

Signs and Symptoms of Acute Renal Failure

- OLIGURIA
- proteinura
- hematuria
- LOSS OF APPETITE
- nausea/vomitting
- fatigue
- edema
- itchy skin

Acute Renal Failure can progress to

Chronic Renal Failure

Treatment for Acute Renal Failure

- May nee short-term dialysis.

Nutrition Therapy for Acute Kidney (renal) Failure

- Goal is to improve or maintain nutritional status
- Parenteral nutrition therapy may be required
- Recommendations for protein intake have been debated
- Individualized therapy based on renal function (indicated by golmerular filtration rate)

Prevent break down of protein

Catabolism

Test to figure out Kidney functioning

- glomerular filtration rate

Chronic Kidney Failure

- Caused by progressive breakdown of renal tissue, which impairs all renal functions
- Develops slowly
- No cure (other than kidney transplant)

Signs and Symptoms of Chronic Kidney Failure

- Polyuria/oligura/anuria
- Electrolyte imbalances
- Nitrogen retention
- anemia
- Hypertension
- Azotemia
- Weakness
- Shortness of Breath
- Fatigue
- Thirst
- Appetite loss
- Bleeding
- Muscular twitching

Nutrition Therapy for Chronic Kidney Failure

- Reduce protein breakdown
- Avoid dehydration or excess hydration
- Correct acidosis
- Correct electrolyte imbalances
- Control fluid and electrolyte losses
- Maintain optimal nutritional status
- Maintain appetite and morale
- Control complications of hypertension, bone pain, nervous system involvement
- Slow rate of renal failure

Diet Therapy for Chronic Kidney Failure

- Provide enough protein therapy to maintain tissue integrity while avoiding excess
- Provide amino acid supplements for protein supplementaion
- Reserve proteinfor tissue synthesis by ensuring adequate carbs and fats
- Maintain adequate volume with water
- Possibly restrict sodium, phosphate, calcium
- Supplement diet with multivitamin

Amount of Carbs needed for Chronic Kidney Failure

- 35 kCal per Kg of body weight per day

End-stage Kidney Disease

- Occurs when patient's glomerular filtration rate decreases to 15 ml/min
- Irreversible damage to most nephrons
- Dialysis or transplant are only options for treatment

Hemodialysis

- Usease an artificial kidney machine to remove toxic substances from blood, restore nutrients and metabolites
- Two to three treaments a week
- Patient's blood makes sever "round trips" through machine
- Dialysis solution (dialysate) removes excess waste material

Nutrition Therapy for a Patient on Hemodialysis

- Maintain protein and energy balance
- Prevent dehydration or fluid overload
- Maintain normal serum potassium and sodium levels
- Maintain acceptable phosphate and calcium levels.

Other Dietary Concerns for a Patient on Hemodialysis

- Avoid protein energy malnutrition by careful calculation of protein allowance
- Maintain body mass index of 25 to 28 kg/m2
- Fluid Intake: 1,000 ml/day plus amount equal to urine output
- Limit sodium 2,000 mg/day
- Limit Potassium 2,000-3,000 mg/day
- Supplement of water-soluble vitamins (B complex, C)

High Biological Value of Protein

Eggs
Fish
Lean Meant
Poultry

Peritoneal Dialysis

- Performed at home
- Patient introduces dialysate solution directly into peritoneal cavity 4-5 times per day
- Surgical insertion of permananent Catheter is required
- Disposable bag containing dialysate solution is attached to catheter
- Diet is more liberal than with hemodialysis

Nutrition Therapy for a Patient on Peritoneal Dialysis

- Increase protein intake to 1.2 to 1.3 g/kg body weight
- Increase potassium with a wide variety of fruits and veggies
- Encourage liberal fluid intake of 1500 to 2000 ml/day
- Avoid sweets and fats
- Maintain lean body weight.

Osteodystrophy

- Bone disease resulting from defective bone formation
- Found in about 40% of patients with decreased kidney function and 100% of patients with kidney failure

Neuropathy

- Central and Peripheral Neurologic Disorders
- Found in up ot 65% of patients at the initiation of dialysis

Long-Term Complications of Chronic Kidney Disease

- Osteodystrophy
- Neuropathy

Kidney Stones

- Basic cause is unknown
- Factors relating to urine or urinary tract environment contribute to formation
- Present in 5% of U.S. women and 12% of U.S. men

3 major substances that for Kidney Stones

- Calcium
- Struvite
- Uric acid

Reason why kidney stones happen more in men

Porstate gland blocks
Estrogen in women helps prevent by keeping urine alkaline

Most common type of Kidney Stone

Calcium Stones

Calcium Stones

- 70-80% of kidney stones are calcium oxalate
- Almost half result from genetic predisposition
Caused by
- Excess calcium in blood (hypercalcemia) or urine (hypercalciuria)
- Excess oxalate in urine (hyperoxaluria)
- Low levels of citrate in urien (hypocitraturia)
- Infection

Food Sources of Oxalates

- Fruits: berries, concord graps, currants, figs, fruit cocktail, plumbs rhubarb, tangerines
- Veggies: Baked/green/wax beans, beat/collard greens, beets, celery, swiss chard, chives, eggplant, endive, kale, okra, green peppers, spinach, sweet potatoes, tomatoes
- Nuts
- Cocoa, draft beer, tea
- Grits, tofu, wheat germ

Struvite Stones

- Composed of magnesium ammonium phosphate
- Mainly caused by urinary tract infections rather than specific nutrient
- No diet therapy is involved
- Usually removed surgically

Cystine Stones

- Cuased by genetic metabolic defect
- Occur rarely

Xanthine Stones

- Associated with treatment for gout and family histroy of gout
occur rarely

Uric Acid Stones

usually results from impaired metabolism of purine (gout, wasting disease)
Dont eat food with purines

Food with Purines

- Anchovies
- Sardines
- Organ meats
- Legumes, mushrooms, spinach, asparagus, cauliflower
- Alcohol
- Yeast
- Poultry

Symptoms of Kidney Stones

- Sever pain, back pain, fatigue
- Other urinary symptoms
- General weakness
- Fever

Several Considerations for Treatment of Kidney Stones

- Fluid intake to prevent accumulation of materials
- Dietary control of stone constituents
- Achievement of desired pH of urine with medication
- Use of binding agents to prevent absorption of stone elements
- Drug therapy in combination with diet therapy

Diet Therapy for Kidney Stones

******* INCREASE FLUIDS
- Decrease vitamin c and calcium intake
- Lower protein and salt in the diet
- Low purine diet for uric acid stones
- Low protein diets for cystine stones
- Increase intake of high fiber foods and phytates (whole grains) they bind with the elements that form the stones so they can be excreted.

Diet Therapy for Cystine Stones

- Low-methionine diet (essentially a low-protein diet) sometimes recommended
- In children, a regular diet to support growth is recommended
- Medical drug therapy is used to control infection or produce more alkaline urine

Diet Therapy for Calcium Kidney Stones

- Normal calcium
- Lower protein and salt

Diet Therapy for Phosphate Kidney Stones

- Low phosphorus (1,000-1,200 mg)

Diet Therapy for Oxalate Kidney Stones

- Low oxalate

Diet Therapy for Struvite Kidney Stones

- Low phsophorus (1,000-1,200 mg/day)
- Associated with urinary infections

Functional Units of the Kidneys

Nephrons
- Through these the kidney maintains life-sustaining blood levels of materials required for life and health

The nephrons accomplish their tremendous task by constantly

"laundering" the blood many times each day, returning necessary elements to the blood and eliminating the remainder in concentrated urine

At its end stage, chronic kidney disease is treat by

dialysis or kidney transplantation

Dialysis patients require close monitoring for

protein, water, and electrolyte balance

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