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FSN 430 Renal

Terms in this set (58)

​How long does the typical hemodialysis treatments take on average?
​4 hours
​Medical and nutritional management of acute kidney injury typically aim to maintain BUN (blood urea nitrogen) in the range of:
​80-100 mg/dL
​The interdialytic weight gain goal in HD patients should not exceed what percentage of body weight?
​5%
​The onset of renal failure is not usually apparent until what percentage of renal function is lost?
​50-70%
​What fruits are low in potassium?
Select one:
​apples, grapes, raspberries
​What is often one of the first signs of renal insufficiency?
​microalbuminuria
​What is the term for blood in the urine?
hematuria
​What pituitary hormone works at the level of the collecting duct to either increase or decrease absorption of water in order to maintain plasma volume and thus blood pressure?
​vasopressin
What structure in the kidney collects the glomerular filtrate?
​Bowman's capsule
Since most HD patients receive anticoagulation therapy, caution must be taken if supplementing with________due to its role in promoting clot formation.
vitamin K
​In general, the hemodialysis diet is high in protein and controls intakes of potassium, phosphorus, fluids, and sodium. (T/F)
True
​Triglyceride levels are particularly reduced in PD patients due to the absorption of glucose from the dialysate. (T/F)
False
Fxns of the kidney
Regulatory
-fluid balance, acid-base balance, Ca-Phos balance, electrolyte balance, BP
Excretory
-removes waste and excess fluid
Endocrine
-erythropoietin (EPO), 1, 25 Dihydroxycholecalciferol
nephron anatomy
contains glomerulus within Bowman's capsule
-afferent arteriole: blood to glomerulus
-efferent arteriole: blood away from glomerulus
tubules
-proximal convoluted
-loop of henle
-distal convoluted
-collecting duct
what is GFR and what is it an indicator of?
glomerular filtration rate
-good indicator of kidney fxn
-nl= 135-200L/d = ~125ml/min
what is obligatory urine? how much?
the minimal amount of fluid/urine loss from the body
- >/= 500ml
what is the solute load representing end waste products of normal metabolism?
600 mOsm
500-1200 mOsm
oliguria
<400 ml/d urine
anuria
<50 ml/d urine
purpose of EPO
erythropoietin
-RBC production
purpose of 1,25-(OH)2 Vit D
bone metabolism
what do you look at to assess kidney fxn?
-microalbuminuria
-GFR
-clearance calculations
-tubular fxn tests
-microscopic evaluation of urine
-radiologic evaluation
-biopsy
CKD definition and characteristics
syndrome in which progressive & irreversible loss of kidney fxn occurs
- GFR <60ml/min/1.73m(^2), >3mo
- 5 stages
-slow progression to stage 5
- requires medication and specialized diet
what is the main cause of mortality in pts with CKD?
CVD
CKD Stage 1
- kidney damage with nl or increased GFR
- >/= 90 GFR
- action: diagnosis & treatment, treatment of comorbid conditions, slow progression, CVD risk reduction
CKD Stage 2
-kidney damage with mild decrease in GFR
- 60-89 GFR
- action: estimating progression
CKD Stage 3
-moderate decrease in GFR
- 30-59 GFR
- action: evaluating and treating complications
CKD Stage 4
-severe decrease in GFR
- 15-29 GFR
-action: preparation for kidney replacement therapy
CKD Stage 5
-kidney failure
- <15 GFR (or dialysis)
-action: replacement (if uremia present)
CKD S/Sx
Na retention, edema, HTN (GFR < 15 ml/min)
hyperkalemia
hyperphosphatemia
metabolic acidosis (GFR < 25 ml/min)
uremia, azotemia
oliguria (15% of GFR)
anemia
bone and mineral disorders (osteodystrophy)
osteodystrophy
dystrophic (wastes away) growth of the bone
etiology of CKD
diabetes (39%)
HTN (28%)
glomerulonephritis (13%)
hereditary cystic & congenital renal disease (4%)
interstitial nephritis & pyelonephritis (4%)
neoplasm/tumor (2%)

risk factors: ethnicity (AA with DM highest)., fam hx; hereditary, gender (males), smoking, direct/forceful blow to the kidneys, heavy consumption of OTC painkillers, obesity
comorbid conditions of CKD
anemia (decreased EPO production)
secondary hyperparathyroidism (overstimulation of parathyroid)
CVD (inflammation, Ca/Phos imbalance, hyperlipidemia)
CKD Assessment (Cr)
Creatinine
-male: 0.8-1.2 mg/dl
-female: 0.6-1.0 mg/dl
-if ~10mg/dl, dialysis needed
-increased with renal failure, inadequate dialysis
- increased with dehydration and catabolism
-decreased if muscle mass is low
CKD Assessment (BUN)
Blood Urea Nitrogen
-nl= 10-20 mg/dl
-goal is less than 50 mg/dl
-usually not symptomatic until 80 mg/dl
- increased if renal failure, inadequate dialysis, dehydration, GI bleeding/trauma, malnutrition, heart failure, high pro intake
- decreased if low pro intake, overly aggressive dialysis, overhydration, liver damage
CKD Assessment (BUN:Cr ratio)
nl= ~20:1, both are normal

pre-renal, dehydration: >20:1, both increased, or just increased BUN

intrinsic renal damage: 10-20:1, both increased
CKD Assessment (Na)
Sodium
136-145 mEq/L
CKD Assessment (Mg)
Magnesium
1.5-2.2 mEq/L
-may be increased with late stage CKD
CKD Assessment (Ca)
Calcium
8.5-10.5 mg/dl
-decreased with renal dysfunction d/t decreased active Vit D3
-must be corrected with hypoalbuminemia
CKD Assessment (K)
Potassium
-nl= 3.5-5.0 mEq/L
-increased with renal failure, trauma, infection, dehydration, diuretics, inadequate dialysis, excessive intake relative to GFR
-restriction if urine output is less than 1 L or if serum levels increased
CKD Assessment (Phos)
Phosphorus
nl= 3-4.5 mg/dl
-increased with renal failure, osteodystrophy, excessive intake, inadequate P binder
CKD Assessment (Hgb/Hct)
male
-hgb: 14-18 g/dl
-hct: 42-52%
female
-hgb: 12-16 g/dl
-hct: 37-47%
CKD Assessment (pH)
7.35-7.45
CKD Assessment (HCO3)
24-29 mEq/L
CKD Assessment (Serum Alb)
3.5-5 g/dl
proteinuria
urine protein is elevated
-protein </= 0.8 g/kg, even if alb is low
Overall goals of MNT
-prevent nutrient deficiencies/excess (pro, energy, vitamins, minerals)
-electrolyte balance (Na, K)
-prevent renal osteodystrophy (Ca, Phos, vit D)
-control edema (limit fluid)
-provide a palatable, attractive diet
MNT Stages 1 & 2
focus on co-morbid conditions
-DM
-HTN
-hyperlipidemia
-slow progression of CVD
MNT Stages 3-5
-energy = 30-35 kcals/kg
-pro (GFR < 25 ml/min) = 0.6-0.8 g/kg)
-limit phos, Ca, K, vit A & C
-fluid may need adjustment
indicators for HD or PD
non-DM: serum Cr 4-6 mg.dL
DM: Cr clearance <15 mL/min

other:
pericarditis, uncontrolled fluid overload, pulmonary edema, uncontrolled and repeated hyperkalemia, lethargy, coma
Hemodialysis overview
passing blood across selective membrane exposed to rinsing fluid (dialysate)
membrane is man-made dialyzer (artificial kidney)
access sites
- arteriovenous fistula (AVF) - joining of artery and vein (preferred)
-arteriovenous graft (AVG) - teflon
typical regimen: 3 days/wk for 4 hrs/treatment at a dialysis unit
Peritoneal Dialysis overview
lining of patient's peritoneal wall serves as the selective membrane
types:
- CAPD- continuous ambulatory
- CCPD- continuous cycling
access via catheter into peritoneal cavity
range of dextrose concentrations
dwell time and number of exchanges
nutrition goals for dialysis
meet requirements
prevent malnutrition
minimize uremia
minimize complications
maintain fluid status (BP)
HD nutrient characteristics
1.2 g/kg pro
control intake of : K, Phos, Na(2g/d), fluids(1 L/d until urine output increases)
PD nutrient characteristics
generally more liberalized
higher intakes of : pro (1.2-1.3 g/kg), K, Na(2-4g/d), fluid (2 L/d)
limit Phos intake
excess kcals may be a problem
60% gluc in dialysate absorbed (100-200 g/day)
Fat and Dialysis
increased risk for CAD and stroke
-HD typically have normal HDL, LDL, TG
-PD higher TC, LDL, TG
-recommended TLC diet guidelines for both
nephrolithiasis
kidney stones (Ca oxalate/phosphate, struvite, cystine/uric acid)
crystallization of urine
risk factors: climate, diet, low H2O intake, fam hx, genetic disorders, 3x more common in men, ethnicity, GI surgery or IBD, meds (diuretics, excessive vit D), UTI
nephrolithiasis MNT
increase fluid ~3-3.5 L (1/2 from water) -- goal 2L urine
adequate Ca
limit high oxalate foods
DASH diet; reduce animal pro
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