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31 Cards in this Set
- Front
- Back
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Normal Kindey Function
Excretory |
Excretion of metabolic waste
- Urea - Creatinine - Uric Acid |
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Normal Kindey Function
Regulatory |
Regulation of Fluid
Electrolyte Balance Acid-base Balance Mineral Balance |
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Normal Kindey Function
Endocrine |
Erythropoietin- red blood cell stimulation
Calcitrol- Regulate serum calcium |
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Nephron
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Functional unit of the kidney
Smaller units- Glomeruli Fluid and other materials reabsorbed into the blood stream |
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Bowmans Capsule
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Surrounds Glomerulus
Functions like a sieve Allows small solutes and fluid to enter the nephrons tubule system |
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Glomerular Fitration Rate (GFR)
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Used to monitor kidney function
Normal - 120ml/min |
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Blood Regulation Kidney 3
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Filtration
Reabsorption Secretion |
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Nephrotic Syndrome
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Damage to the glomerular base, increase permeability to protein
Large quantities of Protein in the urine |
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Nephrotic Syndrome Characteristics
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Poor appetite
Muscle wasting Undernutrition Edmema Dyslipidemia |
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Nephrotic Syndrome Maintenance
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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 |
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Acute Renal Failure
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Sudden delicne in GFR
At high risk for undernutrition Metabolic changes accelerate degradation of protein and AA resulting in loss of LBM |
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Acute Renal Failure Causes
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Infection
Exogenous Nephrotoxins Trauma Dehydration Shock resulting in Ischemia |
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Acute Renal Failure Consequences
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Edema- Early due to absence of urine or oliguria (< 400ml/day)
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Acute Renal Failure Consequences Fluid and Electorlyte
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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 |
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Acute Renal Failure Consequences Uremia
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Accumulation of nitrogen containing waste products
- BUN - Creatinine - Uric Acid Catabolic state produces additional nitrogen Symptoms - Lethargy - Confusion - Headaches - Anorexia |
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Acute Renal Failure Primary Goal
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Prevent further damge to the kidneys by treating the underlying illness
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Acute Renal Failure Maintenance
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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 |
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Chronic Kindney Disease
Definition |
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 |
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ESRD
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End Stage Renal Disease
Inability of the kidneys to excrete waste products, maintain fluids and electrolytes and balance hormones. |
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Clinical Signs of ESRD
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Malaise, fatigue, anorexia, vomiting, decreased mental concentration.
Fluid accumulation electrolyte imbalance Wasting Anemia Dyslipidemia Bones disorders |
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Five stages of Chrnic Kidney Disease
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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) |
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Goals for Stages 1-4
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Slow rate of disease progression
- Control BP - Control DM - Restrict protein intake Decrease risk of CVD Prevent malnutrition |
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Preventing malnutrition in ESRD patients
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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 |
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Goals for Stage 5
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Control Symptoms
Prevent Malnutrition Prevent Complications - Bone Disease, CVD Control BP and DM |
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Osteodystrophy
Factors |
Lack of Active Vit. D
Low serum Ca Eleavated P levels |
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Osteodystrophy Treatment
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Decrease serum phosphate
- Diet - Phosphate Binders Calcitrol Supplements - Calcium |
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Renal Dialysis
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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 |
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Hemodialsis
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MOST COMMON
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 |
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Peritoneal Dialysis
Two Types |
LESS COMMON
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) |
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Nutrional Supplements for Dialysis Patients
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Folate, ribaflavin, vitamin B6 and C
NO Fat soluable vitamins A,D,K Calcium 1-1.5g/day NO Antacids Containing Mg P restrictions |
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Renal Transplant
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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 |
