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DIET THERAPY EXAM 4

Terms in this set (58)

Describe the functions of the kidney.
1. Filters blood
◦ Eliminate fluids or reabsorb fluids
◦ Maintain electrolyte balance
◦ Maintain acid-base balance
◦ Forms urine
◦ Filters metabolic waste products ... creatinine, urea (protein metabolism)

2. Regulate Blood pressure
◦ Renin

3. Stimulate RBC production

4.Stimulate bone structure
◦ Activate vitamin D
What is acute kidney injury? When can it occur? What is treatment?
• The decline of kidney function short amt of time. Usually can be reversable


• Causess*:
◦ are typically in hospital
◦ Critical illness
◦ Sepsis
◦ Major surgery

• Treatmentt*:
◦ Dialysis
◦ Diet
◦ Meds
What is chronic kidney disease (CKD)?
• Characterized by gradual, irreversible deterioration of the kidney

• Causess*:
◦ Diabetes 44%
◦ HTN 28%
◦ Affects 15% of adults
What blood tests are used to monitor for those with CKD? In predialysis, are these blood tests
usually low, normal, or elevated?
• Blood tests
◦ Blood urea nitrogen (BUN)
◦ Creatinine

• Urine albumin
◦ Increases with kidney disease

• Glomerular filtration rate
◦ Calculated from how much creatinine in the blood
What are the consequences of CKD?
• Decreased glomerular filtration rate (GFR)- the kidneys ability to filter
◦ Increased potassium and phosphorus in blood
◦ Increased protein metabolites in the blood
• Blood urea nitrogen (BUN)
• Creatinine
• Uric Acid

• Cardiovascular complications
◦ Fluid and electrolyte imbalance
◦ Heart arrhythmias

• Anemia
◦ Decreased erythropoietin production

• Bone disease
◦ Vitamin D not activated
◦ Lowered blood Ca levels

• Growth failure and wasting syndrome

• GI disturbances

• Uremia
◦ Accumulation of N waste products in the blood
Define hemodialysis.
Blood is circulated through a dialyzer (artificial kidney) where it is bathed by a dialysate, a solution that selectively removes fluid and wastes
Compare diet therapy for predialysis and hemodialysis. Why do they differ?
• Recommendations vary based on disease progression and individual

• Energy: needs often high
◦ Protein energy malnutrition
• Primary: poor dietary intake
• Secondary: N and V, restrictive diets, uremia, medications

• Fluids
◦ Urine output plus 500-1000 ml/day
◦ Dialysis: 2 lb water gained/day

• Protein
◦ Pre dialysis: some restriction
◦ Dialysis: no protein restriction
• Can remove N waste products
• Lose some AA in dialysate

• Sodium
◦ Most patients need some restriction

• Potassium
◦ Depends on serum K levels
◦ Hemodialysis: restricted to 2000-3000 mg
• Restricts some fruits and veggies
• Lists of high, medium, low K foods

• Phosphorus
◦ Restricted with increased serum phosphorus levels
◦ Phosphate binders
What is a phosphate binder and why is it used?
Binds to phosphorus, doesn't get absorbed, eliminated through the feces
Define the following: atherosclerosis, angina pectoris, myocardial infarction, transient ischemic attack, ischemic stroke, hemorrhagic stroke, thrombosis, and embolism.
Atherosclerosis: thickening due to plaque buildup "hardening of the arteries"

Angina pectoris: chest discomfort due to insufficient blood flow to heart

Myocardial infarction: aka heart attack

Transient ischemic attack: insufficient blood supply to the brain

ischemic stroke: • blockage of blood flow to brain
• Often plaque ruptures and blood clots form
• 87% of strokes are ischemic
• Lack of blood flow leads to brain damage

hemorrhagic stroke: • Due to bleeding in brain
• Atherosclerosis weakens the blood vessels
• Chronic HTN
• Bleeding damages brain

thrombosis: the formation or presence of a blood clot in the vascular system

embolism: obstruction of a blood vessel caused by a traveling clot
In general terms, how does atherosclerosis develop? What are the consequences?
DEVELOPMENT:
• Injury to interior of blood vessel wall
• Inflammatory response to injury
• LDL slip under the inner lining of the artery and become oxidized
• LDL plus immune cells become foam cells
• Smooth muscle cells form a "scab" over the fatty lesion
• =PLAQUE
• Narrowed blood vessels result

CONSEQUENCES:
• Coronary arteries: Myocardial infarction
• Aneurysm - blood vessels become expanded and weak. Can rupture and cause death
• Brain
- TIA (transient ischemic attack)
-CVA (cerebrovascular accident= stroke)

• Peripheral circulation
• Kidneys - kidney disease
List the risk factors for CHD. Which are modifiable? Which are impacted by diet?
look at table 27.1 in book/slides
Know the desirable laboratory levels for CHD: total cholesterol, LDL cholesterol, HDL cholesterol. What other lab measures are important for CHD risk (see table 27-2)?
• Total Cholesterol <200 mg/dL
• LDL Cholesterol <100 mg/dL
• HDL Cholesterol >60 mg/dL
Discuss the dietary recommendations, rationale, food sources to limit/consume for the following:
a.Total fat
b.Saturated fat
c.Polyunsaturated or monounsaturated fat
d.Trans fat
e.Dietary cholesterol
f.Soluble fiber
g.Plant sterols and stanols
h.Alcohol
• Limit Saturated Fats
• <10% of total kcals
• <7% of total kcals if you have significant risk
• Butter, meat fat, some fairy, (palm oil, coconut oils, etc)

Dietary Interventions
• Unsaturated fats
• Replace saturated fats with mono and polyunsaturated fats
• Omega 3 fats
• Fish
• Flaxseed

Dietary Cholesterol
• Role not clear
◦ Usually foods high in cholesterol also high in saturated fat
◦ Current recommendations for those at risk
<200 mg/day
• Total fat
◦ 20-35% of total kcals (AMDR)

• Trans Fats
◦ Raise LDL levels similar to saturated fats
◦ Hydrogenated fats
◦ Dietary intake: low as possible
◦ Baked goods, crackers, sweets, etc
What are lifestyle recommendations to reduce CHD?
...
What is a lipoprotein? What is the role of a chylomicron, VLDL, LDL, and HDL?
Lipoprotein
• Major carriers of lipids in the plasma
• Clusters of lipids associated with proteins that serve as transport vehicles for lipids in the lymph and the blood

Chylomicrons:
-transports fat from intestine (diet)

VLDL:very low density lipoprotein (transports fat from the Liver

LDL: Low density lipoprotein (supplies cholesterol to the body)

HDL: High density lipoprotein (reverse transports cholesterol (back to liver)
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