STAGE 4 KIDNEY DISEASE
Case Study Presentation
Abby Owsinski
Sodexo Dietetic Intern
June 9, 2015
OBJECTIVES
Define Kidney Disease
 Differentiate between the stages of kidney
disease- Stage 1 through End Stage Renal
Failure
 Present Case Study
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WHY KIDNEY DISEASE?
Family History
 Experience
 Renal Rotation
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STATISTICS FROM NKF
“1/2 of Americans don’t understand that healthy
kidneys are are responsible for creating urine.”
 “ Over 26 million American adults have kidney
disease, and most don’t know it.”
 More than 40% of people who go into kidney
failure each year fail to see a nephrologist before
starting dialysis- a key indicator that kidney
disease isn’t being treated in its earliest stages.”
 “ In 2011, more than 92,000 Americans died from
causes related to kidney failure.”
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KIDNEYS
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Two kidneys
Each about the size of a fist, located on either side of
the spine at the lowest level of the rib cage
Contain up to a million functioning units called
nephrons
Major function of the kidneys is to remove waste
products and excess fluid from the body
Regulate body’s sodium, potassium and acid content
Produce hormones that impact other organ function
Filter and return to the bloodstream about 200 quarts
of fluid every 24 hours
KIDNEY DISEASE
Chronic kidney disease is defined as having some
type of kidney abnormality or “marker” such as
protein in the urine and having decreased kidney
function for three months or longer.
 Stage Four CKD- likely to need dialysis or kidney
transplant
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SIGNS OF KIDNEY DISEASE
Albumin/protein in the urine
 High blood pressure
 Ankle and leg swelling, leg cramps
 Going to the bathroom more often at night
 High levels of BUN and creatinine in blood
 Less need for insulin or antidiabetic medications
 Morning sickness, nausea and vomiting
 Weakness, paleness and anemia
 Itching
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CAUSES OF KIDNEY DISEASE
Diabetes
 High Blood Pressure
 Glomerulonephritis
 Polycystic Kidney Disease
 Kidney Stones
 Urinary Tract Infections
 Congenital diseases
 Drugs and toxins
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RISK FACTORS
Age
 Family history of CKD
 African American, Hispanic American, Asians
and Pacific Islanders
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TESTS FOR KIDNEY DISEASE
ACR
GFR
Normal
< 30mg
>90 ml/min
Stage 4 CKD
30-300mg
15-29 ml/min
End Stage CKD
30-300mg
< 15ml/min
CASE STUDY
TO- 82 year old Caucasian male
 Ht:5’10” Wt:182 lbs, 82.7kg
BMI:26
 Past Medical History: bladder cancer, prostate
cancer, hypothyroidism, HTN, peripheral
vascular disease, vitamin D deficiency, Stage 4
CKD
 Family Medical History: Mother and brother
passed away from kidney failure ( brother
received hemodialysis)
 Social History: nonsmoker, daily physical
activity, no drug use, alcohol on special occasions
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KEY FACTORS
Lifestyle
 Family History
 History of interrelated conditions
 Diet- ethnic foods
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INITIAL VISIT
Outpatient at St. Lukes in Coaldale
 Patient not following a diet at home
 Unaware of dietary restrictions for renal disease
 Pt has received blood work to test renal labs
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FOLLOW-UP VISIT
Renal Labs- Slight improvement
 Dietary Changes- Good Compliance
 Exercise- more regular exercise
 Weight Loss- desired loss achieved
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No symptoms related to CKD reported at this
time
MEDICATION LIST
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Zoladex
Ketoconazole
Cortef
Synthroid
Nexium
Norvasc
Detrol LA
Lipitor
Calcium +D with Magnesium and Zinc
Vitamin D
Vitamin B12
Omega 3 Krill Oil
LAB VALUES TESTED 1/14/15
BUN- 32H (from 35)
 CR- 2.25 H (from 2.30)
 GFR- 29.9 ( from 30.4)
 Sodium- 139 (from 141)
 Potassium- 4.8 ( from 4.5)
 Phosphorus- 3.6 ( from 3)
 Calcium- 9.5 ( from 9.3)
 Albumin- 4.3 ( from 4.0)
 Glucose- 96 (from 93)
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TREATMENT OPTIONS
Dialysis is the only means of taking care of your
body’s needs when your kidneys no longer
function
 When should TO consider Dialysis?
 Dietary Changes ?
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DIALYSIS
Hemodialysis
- Fistula , Graft, Catheter
 Peritoneal Dialysis
 Life Expectancy
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DIETARY CHANGES
Protein
 Potassium
 Phosphorus
 Sodium
 Sweets
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CKD SUMMARY
RESEARCH
Early Detection and Screening
 Treatment Initiation
 Cost $$$$
 Genetics
 Epidemiology
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SUPPORT
National Kidney Foundation
- Awareness Campaign
 https://www.kidney.org/everybodypees
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Davita
- Educational Videos
 http://www.davita.com/videos
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RESOURCES
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1. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation Practice
Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Ann Intern Med.
2003;139:137-147. doi:10.7326/0003-4819-139-2-200307150-00013
2. Ryu, J., Cha, R., Kim, D., Lee, J., Yoon, S., Ryu, D., . . . Investigators, A. (n.d.). The Clinical Association of
the Blood Pressure Variability with the Target Organ Damage in Hypertensive Patients with Chronic
Kidney Disease. Retrieved March 30, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101784/
3. Fishbane, S., Hazzan, A. D., Halinski, C., & Mathew, A. T. (2015). Challenges and opportunities in latestage chronic kidney disease. Clinical Kidney Journal, 8(1), 54–60. doi:10.1093/ckj/sfu128
4. Mohebi, R. (n.d.). Obesity Paradox and Risk of Mortality Events in Chronic Kidney Disease Patients: A
Decade of Follow-up in Tehran Lipid and Glucose Study. Retrieved April 1, 2015, from
http://www.jrnjournal.org/article/S1051-2276(14)00259-3/abstract
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5. Mahan, K. (2012). Krause's food and the nutrition care process. (13 ed.). St. Louis, Missouri: Elsevier
Saunders.
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6. About Chronic Kidney Disease. (n.d.). Retrieved March 22, 2015, from
https://www.kidney.org/kidneydisease/aboutckd#facts
7. Stage 4 of Chronic Kidney Disease. (n.d.). Retrieved March 30, 2015, from http://www.davita.com/kidneydisease/overview/stages-of-kidney-disease/stage-4-of-chronic-kidney-disease/e/4751