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31 Cards in this Set

  • Front
  • Back
Normal Kindey Function
Excretion of metabolic waste
- Urea
- Creatinine
- Uric Acid
Normal Kindey Function
Regulation of Fluid
Electrolyte Balance
Acid-base Balance
Mineral Balance
Normal Kindey Function
Erythropoietin- red blood cell stimulation
Calcitrol- Regulate serum calcium
Functional unit of the kidney
Smaller units- Glomeruli
Fluid and other materials reabsorbed into the blood stream
Bowmans Capsule
Surrounds Glomerulus
Functions like a sieve
Allows small solutes and fluid to enter the nephrons tubule system
Glomerular Fitration Rate (GFR)
Used to monitor kidney function
Normal - 120ml/min
Blood Regulation Kidney 3
Nephrotic Syndrome
Damage to the glomerular base, increase permeability to protein
Large quantities of Protein in the urine
Nephrotic Syndrome Characteristics
Poor appetite
Muscle wasting
Nephrotic Syndrome Maintenance
Moderate protein restriction (0.8-1g/kg)
Approx 35 kcals/kg dry weight
Limit Sat fat to <7% and Cholesteral < 200mg/day
Sodium <2000mg/day
Monitor potassium
May require vit. D and calcium supplements
Acute Renal Failure
Sudden delicne in GFR
At high risk for undernutrition
Metabolic changes accelerate degradation of protein and AA resulting in loss of LBM
Acute Renal Failure Causes
Exogenous Nephrotoxins
Shock resulting in Ischemia
Acute Renal Failure Consequences
Edema- Early due to absence of urine or oliguria (< 400ml/day)
Acute Renal Failure Consequences Fluid and Electorlyte
Sodium retention contributes to edema
Hyperkalemia - can alter heart rate and lead to heart failure
Hyperphosphatemia - reduce blood calcium levels and increase secretion of parathyroid hormone
Acute Renal Failure Consequences Uremia
Accumulation of nitrogen containing waste products
- Creatinine
- Uric Acid
Catabolic state produces additional nitrogen
- Lethargy
- Confusion
- Headaches
- Anorexia
Acute Renal Failure Primary Goal
Prevent further damge to the kidneys by treating the underlying illness
Acute Renal Failure Maintenance
35 kcal/kg/day
Protein restrice to 0.6-0.8g/kg unless on dialysis
Estimated fluids- Urine Output + 500ml
Electrolyte- Na limited to 2-3g/day
Chronic Kindney Disease
Progressive irreversible loss of kindey function
When 1/2-2/3 of renal function lost
Urea and other waste products accumulate in the blood
Resulting condtion uremia
End Stage Renal Disease
Inability of the kidneys to excrete waste products, maintain fluids and electrolytes and balance hormones.
Clinical Signs of ESRD
Malaise, fatigue, anorexia, vomiting, decreased mental concentration.
Fluid accumulation electrolyte imbalance
Bones disorders
Five stages of Chrnic Kidney Disease
1. Kindney Damage with Normal/increased GFR (>90ml/min)
2. Kidney damge with midly decreased GFR (60-89ml/min)
3. Moderately decreased GFR (30-59ml/min)
4. Severely decreased GFR (15-29ml/min)
5. Kidney Failure (GFR< 15ml/min)
Goals for Stages 1-4
Slow rate of disease progression
- Control BP
- Control DM
- Restrict protein intake
Decrease risk of CVD
Prevent malnutrition
Preventing malnutrition in ESRD patients
PROVIDE adequate energy without exceeding limits for protein, K, Na, P, and fluids
Sources of Energy with limited protein
- Sugars and Oils
- Modular Formulas
- Special products
Goals for Stage 5
Control Symptoms
Prevent Malnutrition
Prevent Complications
- Bone Disease, CVD
Control BP and DM
Lack of Active Vit. D
Low serum Ca
Eleavated P levels
Osteodystrophy Treatment
Decrease serum phosphate
- Diet
- Phosphate Binders
Calcitrol Supplements
- Calcium
Renal Dialysis
Removes waste products and extra fluid
Controls K and Na levels
Helps control BP
DOES NOT remove phosphorus adequately
Removes some AA and Vit's
DOES NOT restore kidney function
Blood pumped through hemodialyzer (artificial kidney)passes through semi-permeable membrane
Dialyzing fluid similar in electrolyte content to normal plasma
Requires 3-5 hours, 3-5 times weekly
Peritoneal Dialysis
Two Types
Dialysate is infused into the peritoneal cavity
- Intermittent: Fluids infused, remians for 20-30 minutes, done for 4-8 hours 3-4 times weekly
- Continuous: Fluid is fused, remians for 406 hours, is drained and replaced (up to 3L)
Nutrional Supplements for Dialysis Patients
Folate, ribaflavin, vitamin B6 and C
NO Fat soluable vitamins A,D,K
Calcium 1-1.5g/day
NO Antacids Containing Mg
P restrictions
Renal Transplant
Normal diet within 6-8 weeks
Protein 1g/kg
Weight gain common
Monitor and adjust K, Na, P, and fluids as needed
Reduce CVD risk, manage DM and HTN