Renal_2012
Due August 17, 2012
RENAL DISEASE PACKET
Name: Jaclyn Lee
PLEASE ANSWER ALL QUESTIONS IN YOUR OWN WORDS.
THE END OF EACH SECTION.
LIST THE APPLICABLE REFERENCES AT
A.) MEDICAL TERMINOLOGY
1. Fill in the blanks in the following table:
BODY PART
Kidney
nephr, ren
PRIMARY FUNTION OF
BODY PART
Collects urine produced by the
kidney
Organ that processes urine
Urine
-uria, urin
Removes waste from blood stream
Example: Renal Pelvis
RELATED ROOT
WORD
pyel
Ureters
ureter
Tubes that propell urine from the
kidneys to the bladder
Bladder
cyst, vesic
Retains the body’s urine until it is
ready to be released
Urethra
ureth
Tube that connects the bladder to
the genitals
2. Break the following words up into their prefix, root and suffix and then provide the meaning
of the word. Not all words will have all three parts.
Medical Term
Prefix & Meaning Root & Meaning Suffix & Meaning
Ex: Nephrotic
-
nephro - kidney
Uremia
Ure-nitrogen
Nephrologist
Nephro - kidney
Anuria
Nephrosis
An- No
tic – pertaining to Pertaining to the
Kidney
emia- blood
High levels of
nitrogenous waste
in the blood
ologist- one who
studies
Uria-urine
Nephro - kidney
-1-
Meaning of
Medical Term
A kidney/renal
physician
A nonpassage of
urine
osis- condition
Kidney disease
Renal_2012
Glomerulonephritis
Nephrolithiasis
Due August 17, 2012
Glomeruloglomerulus
Nephro- kidney lithia-stone
Cystorrhagia
Hemodialysis
Neph - kidney
Hemo-blood
Cystectomy
Polyuria
itis- inflammation Inflammation of
the glomerulus of
the kidney
asis-condition or
state of
Kidney stones
Cyst- bladder
hagia-blood
Blood in the
bladder
dia-throughout
lysis-destruction
Removal of certain
elements in the
blood
Cyst- bladder
ectomu-removal
Removal of all or
part of the bladder
uria-urine
Excessive amounts
of urine
Poly-many
B.) NORMAL RENAL ANATOMY AND FUNCTION
d.
e.
1. Label the parts of the kidney.
c.
b.
f.
a.
g.
List your answers here
a. Renal pyramid
e. Convoluted tubule
b. Ureter
f. Collecting duct
-2-
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Due August 17, 2012
c. Renal artery
g. Loop of Henle
d. Renal Corpuscle
-3-
Renal_2012
2.
Due August 17, 2012
In your own words, discuss the mechanism of action for the following functions of the
kidneys:
a. Blood filtration, excretion and regulation of body wastes.
The kidneys filter small molecules and water in the blood. The red blood cells are too
big to be filtered thats why, under normal conditions, no blood appears in the urine.
The rate of filteration is approximately 125ml/min or 180 liters each day. Most adult
humans have 7-8 liters of blood, meaning the blood gets completly filtered 20-25 times
a day. The kidney is also responsible for removing excess fluid and waste from the
blood it filters. While filtering 180 L of blood, the kidneys produce 1-2 L of urine to
excrete. The urine contains urea, a byproduct of protein metabolism, excess vitamins,
minreals, and metabolites from drugs.
b. Regulation of blood volume, blood pressure and electrolyte balance.
High blod pressure can damage the small blood vessels in the kidnets. When the vessels
are damaged they cannot filter the blood as they should.
c. Acid-base regulation of body fluids
When fluid voluem is low the antidiuretic hormone called vasopressin is released from
the anterior pituitary gland increasing absorption of water in the colecting duct. When
extracellular volume decreases, the renin-angiotensin-aldosterone system is activated
and it excretes less sodium chloride. These systems work together to keep a
homeostatic acid-base balance of body fluids.
d. Gluconeogenesis (occurs under specific condition)
When the body is in a time of insufficent carbohydrate consumption, it breaks down
amino acids in the liver or kidneys into glucose the body can used for immediate
energy.
e. Note: Hormone production is another important function but is discussed in later
sections.
Reference for this section:
http://www.urologyhealth.org/urology/index.cfm?article=24
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Byham-Gray, Wiesen, eds. A Clinical Guide to Nutrition Care in Kidney Disease. ADA, 2004
http://medical-dictionary.thefreedictionary.com/gluconeogenesis
C.) RENAL DISEASES AND CONDITIONS
1.
Define the following as they relate to renal function or disease.
a. Azotemia- Elevated blood urea nitrogen (BUN) and serum creatine circulating in the
blood.
b. Oliguria- A very low output of urine, somewhere between 300-500ml/day. This may be
a sign of dehydration or renal failure.
c. Hyperparathyroid- The excessive production of parathyroid hormone (PTH) by the
parathyroid glands.
c. Glomerular filtration rate (GFR), what does it measure and how is it used?
The GRF measures how much blood passes through the glomerulli in the kidneys each
minute. This test measures how effectivly the kidneys are filtering the blood.
Reference:
http://www.nlm.nih.gov/medlineplus/ency/article/007305.htm
mayoclinic.com
Powerpoints on Kidney Disease from Janet Rouslin RD, JWU.
For each of the following kidney diseases and conditions:
a. I am giving you the definition of the disease or condition
b. I am giving you the causes (etiologies)
c. You describe the physical changes specific to the disease process and progression
(pathogenesis).
d. You explain how the disease impacts the patient’s nutritional status (in some cases there
will be no impact.)
e. You tell me - is a modified diet recommended for this condition? If so what is the diet
prescription?
2.
Glomerulonephritis
a. Definition: Condition resulting from inflammation of the capillaries of the glomeruli.
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Renal_2012
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b. Etiology: Acute GN is most commonly triggered by an infectious process, often
streptococcal, but may also result from drug/toxin exposure, immunological
abnormalities, vascular or other systemic disease. Starts as an acute syndrome but if
underlying cause isn’t treated, may persist in the form of rapidly progressing
glomerulonephritis (RPGN). Chronic GN is often an autoimmune disease.
c. Pathogenesis: Physical changes include blood in the urine, vomit, or stools, fever, loss
of apetite, edema and abdominal pain.
d. Nutritional Status: Nutritional status is based on fluids status and electrolyte balance.
e. MNT: PRotein 0.8-1 g/kg IBW 80%, monitor potassium, sodium, and other minerals,
fluids are unrestricted.
Reference: Powerpoint from JWU, Janet Rouslin RD
3.
Acute Renal Failure
a. Definition: An abrupt decline in renal function with elevation of BUN and plasma
creatinine levels. Oliguria or anuria is common in the first phase, although urine
output may be normal or increased.
b. Etiology: Chronic risk factors include diabetes, heart failure, HTN, other renal disease
or damage, chronic liver disease, advancing age.
Causes may be:
 prerenal (associated with alterations in the blood supply to the kidneys –
hypovolemia, decreased cardiac output, obstruction of renal blood flow);
 intrarenal or intrinsic (damage to the kidney nephrons – inflammatory, lack of
blood flow within the renal tubules, toxic effect of medications or other substances);
or
 postrenal (obstruction to the urinary tract beyond the kidney – stones, UTI,
strictures, tumor.
c. Pathogenesis: There is rapid, often reversible deteroriation of the kidney function,
GFR declines over days, most often occurs during hospitalization.
d. Nutritional Status: Urine output is usually low, dehydration, electrolyte imbalances,
watch BUN and creatinine.
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e. MNT: Energy BEE x1.2-1.3. Protein 0.8-1.2 g/kg. Fluid 24hr urine output plus 500ml.
Sodium 2g, potassium 2g, phosporus 8-15 mg/kg
Reference: Source: Byham-Gray, Wiesen, eds. A Clinical Guide to Nutrition Care in
Kidney Disease. ADA, 2004
4.
Chronic Renal Failure
a. Definition: Progressive and irreversible loss of renal function. May take months to
years to develop.
b. Etiology: Diabetes is the leading cause, uncontrolled HTN is another common cause.
CRF often results from other renal conditions, or from unresolved ARF.
c. Pathogenesis of AFR and glomerulonephritis should be described above. Either can
progress to CRF if not effectively treated. Continue with the pathogenesis from other
causes here: Majority of the incidence comes from DM, or long term uncontrolled
hypertension. GFR rate will continue to decline through the stages of chronic renal
failure.
d. Nutritional Status: Very compromised. Electrolyte imbalances due to edema and
dehydration. caloric intake is ususally low to do lack of appetite.
e. MNT: Protein based on energy expenditure,0.6-0.75 g/kg. No restriction on potassium.
Monitor phosphorus and increase calcium.
Reference: Fedje and Karalis. Nutrition mgt in early stages of CKD. Clin Guide Nutr Care
Kidney Dis, ADA, 2004
5.
End-stage Renal Disease (will discuss diet prescriptions in Nutrition Prescription section,
can leave it out here.)
a. Definition: Final stage of chronic, irreversible kidney failure. Less than 10% of renal
function remains. Treatment with dialysis or transplantation is required.
b. Etiology: May be last stage of chronic disease or resulting from infection or acute
disease. Previous sections should discuss etiology.
c. Pathogenesis: Regain glycemic control if DM is present. Control blood pressure. These
will slow the progression.
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d. Nutritional Status:Prevent deficiencies, control edema and electrolytes, prevent renal
osteodystrophy.
Reference: Powerpoint by JWU, Janet Rouslin RD
6.
Polycystic Kidney Disease
a. Definition: Loss of kidney function due to the formation of multiple fluid-filled cysts in
the kidneys.
b. Etiology: This is most commonly a genetic disease. Autosomal recessive PCK (rare)
occurs in fetuses and infants, half of whom die within a few days of birth, 25% live to
their 10th year. Autosomal dominant PCK (90% of cases) is also genetic but generally
doesn’t manifest until adulthood; symptoms usually start between ages 30 and 50.
A third type is acquired cystic kidney disease (ACKD) most typically occurs in patients
with kidney failure from other causes who have been on long term dialysis.
c. Pathogenesis: Overtime can lead to kidney failure because these cycts cause strain and
damage to the kidneys.
d. Nutritional Status: No impact.
e. MNT: Monitor electrolytes, BUN, creatinine, I&O. Prevent deficiencies.
Reference: http://kidney.niddk.nih.gov/kudiseases/pubs/polycystic/
7.
Renal tubular acidosis
a. Definition: Metabolic acidosis develops because kidneys don’t excrete excess acid into
the urine and/or are unable to retain adequate bicarbonate to buffer the blood.
b. Etiology: May be caused by drug or heavy metal toxicity, by autoimmune disorders,
diabetes, or obstruction. Types 1 and 2 may also be hereditary.
c. Pathogenesis: A secondary disease, so there is more than likely another disease or
conditionn associated with RTA. These other diseases and/or conditions needs to be
treated along with treatment for RTA.
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d. Nutritional Status: Patients with RTA have very acidic blood, some alternative
practices say that eating foods with alkalinizing properties will help treat RTA. Foods
with alkalinizing properties most often contain high levels of potassium which can be
extremely harmful for patients with already high potassium levels due to other kidney
problems.
e. MNT: Recommend electrolytes per lab results. Monitor BUN, creatinine, albumin,
prealbumin.
Reference: http://www.livestrong.com/article/485719-diet-for-renal-tubular-acidosis/
D.) NUTRITION RELATED TOPICS
1.
Describe the process of hemodialysis and how it works. How does CAPD differ from
hemodialysis?
Hemodialysis is a process that removes concentrated molecules and excess fluid from a
patients blood through diffusion and filtration. The patients kidneys (that usually do this
work) are not working efficently enough to properly filer the blood. Threfore the patient
needs to be hooked up to a machine for hours a day so the bood to be filtered. CAPecontinuous ambulatory peritoneal dialysis, is another form of dialysis. In this patients do 45 exchanges of blood per day. A specific volume of dialysate is infused into the patients
peritoneal cavity via a catheter. This dwells in the blod for about 4 hours as excess fluid
and toxins diffuse through the membrane. The dialysate and wates are drained from the
body and this process is repeated.
2.
What is “dry” weight?
Dry weight is the weight of a patient without any excess fluid build up.
3.
Why would a dialysis patient be prescribed a daily water-soluble vitamin supplement
instead of a regular multivitamin?
Fat soluble vitamins like A, D, K, and E are not filtered when on dialysis. Therefore they
can build up to toxic amount and can lead to complications such as anemia and
hypertriglyceridemia.
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Renal_2012
4.
Due August 17, 2012
Discuss the causes of anemia in chronic renal failure. Are iron supplements an effective
treatment? Why or why not?
In patients with CRF, the failing kidneys lack the ability to secrete the hormone
erythropoitein. Erythropoitein is a hormone that stimulates the bone marrow to produce red
blood cells, these red blood cells are what carry oxygen throughout the blood. The iron in
the blood is lost through dialysis, so is folate, an important part in red blood cell
production.
5.
How would a low serum albumin impact your interpretation of calcium labs and why?
Calcium binds to the protein albumin, in the blood. Therefore if serum albumin is low
calcium is also low in the blood.
6.
Describe the influence of dietary oxalates on urinary oxalates. Give examples of foods
with high bioavailability of oxalate that may increase urinary oxalate excretion.
Oxalate is available in many kinds of fruits and vegetables. These foods contain berries,
kiwi, grapes, figs, dark leafy greens, leeks, quinoa, celery, green beans, almonds, cashews,
peanuts, soybeans, chocolate, and balck tea.
Reference for this section:
http://msl1.mit.edu/ESD10/kidneys/HndbkHTML/ch19.htm
http://www.ncbi.nlm.nih.gov/pubmed/11135080
http://www.ncbi.nlm.nih.gov/pubmed/11135080
E.) NUTRITION PRESCRIPTIONS
1.
For each of the following treatments, list the nutrient recommendations in the chart. Then
answer the related questions below in your own words.
Calories
Impaired renal
30-35
function
kcal/kg
(non-dialyzed)
Hemo-dialysis 30-35
kcal/kg
Protein
0.6-1.0
g/kg
1.1-1.4
g/kg
Fluid
Sodium
<2g
5002-3g/day
700+urine
output
Potas-sium
<2g
Phosphorous
Calcium
800-1000 <2000mg/d
mg/day
ay
~40mg/kg individual individual
IBW
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Renal_2012
(CAPD)
Transplant
2.
Due August 17, 2012
30-35
kcal/kg
30-35
kcal/kg
1.2-1.5
individual 2-4g/day
g/kg
1.3-2g/kg individual 80-100
mEq
individual individual individual
individual individual individual
Give the rational for the protein restriction in impaired renal function. What are the hazards
vs. benefits of this practice? What would you monitor to determine the adequacy of protein
intake in these patients?
Overworking impaired kidneys can result in a faster progression of kidney disease or
increased damage. Keeping the protein restricted and frequently monitoring lab values can
track the progress of the kidneys and see if eventually protein can slow be increased.
3.
Why is it recommended for these patients to have at least 50% of their protein from sources
that have high biological value (HBV)?
Protein that comes from sources of high biological value are more beneficial. Patients on
dialysis actually are having some of their protein removed from their bodies and to
replenish that the more efficient way is from a diet rich in high biological value proteins.
4.
Why are CAPD patients allowed more sodium, potassium and fluid than HD patients?
Patients on hemodialysis need to restrict sodium, potassium and fluid more than CAPD
patients because potassium builds between dailysis treatments and can cause complications
such as weakness, muscle cramps, and irregular heartbeats.
5.
When might CAPD patients need more protein than HD patients? Explain why.
Patients on CAPD need more protein because there is a much greater risk for protein
malabsorption than in patients on HD>
6.
Why is fluid restricted in most hemodialysis patients? Make 4 suggestions to help patients
control their fluid intake.
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Fluid restriction will help keep down the swelling, edema and fluid retention in a patient on
hemodialysis. These can be dangerous to the patient by causing shortness of breath,
irregular heart beats and possibly a heart attack.
Suggestions
1. Fill a water bottle with the amout of water allowed in a day and only drink from there.
2. Try drinking out of small cups.
3. If you drink soda, buy the small 8oz cans and after one can, stop drinking soda.
4. If you feel thirsty, sip your water to get your mouth wet without drinking too much per
sip.
7.
Why is potassium a critical restriction in kidney failure?
Damaged kidneys are unable to remove potassium from the blood. High levels of
potassium in the blood can be toxic and cause things like abnormal heart rhythms.
8.
List 6 commonly consumed foods or beverages that are high in potassium and suggest
alternatives that would be acceptable and economical substitutions in menu planning.
HIGH POTASSIUM FOOD
Kiwi
9.
LOWER POTASSIUM ALTERNATIVE
Blueberries
Grapefruit juice
cranberry juice
orange juice
grape juice
asparagus
green beans
spinach
watercress
tomatoes
peppers
List 3 potential problems resulting from an excessive sodium intake in a patient with kidney
failure. Make 4 suggestions to help patients control their sodium and salt intake.
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3 Problems: 1. High blood pressure 2. Fluid retention 3. Hypernatremia
4 Suggestions: 1. Cook more at home- the salt you add to season your food with will
NEVER add up to the sodium in processed foods. 2. Season food with natural flavors such
as citrus zest/juice, spices, herbs, fresh aromatics. 3. Start a garden-eating food as fresh as
can be and in season has the best flavor and often doesnt need any manipulation. 4.Frozen
veggies over canned- in the winter months when fresh produce isnt always cost effective
and readily available, frozen vegetables and fruits are much better than sodium soaked
canned versions.
10. The balance between serum levels of calcium and phosphorus is difficult to maintain in
patients with kidney failure, sometimes resulting in a condition called renal osteodystrophy.
Discuss the following related to this balance:
a. Give at least 3 reasons that serum calcium levels drop with progressive kidney disease.
Calcium levels drop because there is a lack of serum protein (albumin) in the blood.
The calcium binds to the protein, and the protein is not effectively filtered through the
kidneys.
b.
How does kidney failure impact the regulation of calcium-phosphate product (also
known as calcium-phosphate ratio)? How might these changes lead to osteomalcia?
How might they lead to tissue calcification and why is this a critical issue?
Osteomalcia occurs when there is not enough vitamin D in the diet, or there is a
malabsorption of vitamin D by the intestines.
c.
List 5 foods that have the highest levels of phosphorus. Why are phosphate binders
used? What are their nutrition related side effects?
Bran, pumpkin seeds, sunflower seeds, toasted wheat germ, cheese.
d.
What are the diet modifications suggested for renal osteodystrophy?
e.
Would you suggest increasing milk intake to treat low serum calcium levels in a renal
patient? Why or why not?
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Renal_2012
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Milk is a great source of calcium, however when it comes to a patient with renal
conditions it is not the best option. Milk is very high in potassium which can be very
harmful for renal patients.
f.
What is calcitriol and why is it often supplemented in kidney failure. Why must the
response to calcitriol be carefully monitored?
Calcitriol is a form of vitamin D that is used to treat and prevent calcium in the
blood of patients whose kidneys or parathyroid glands are not working efficiently.
Calcitriol will only work if the right amount of calcium is consumed by dietary
sources. If too much calcium is consumed serious side effects may occur. If the patient
is consuming too little calcium then the Calcitriol will not work to treat their condition.
11.
Your patient is starting hemodialysis and has a nutrition prescription of: 35 kcal/kg, 1.2
g protein/kg, 2 g K, 1 g phosphorus, 2 g Na, 1,000 mL fluid + urine output per day;
decrease saturated fat and cholesterol intake. She has approximately 200 ml urine
output per day. Use a weight of 75 kg for the calculations.
Consider her typical intake, plan a sample menu to meet her nutrition prescription. Do
a nutrition analysis to show that your menu meets the recommendations.
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Typical Intake
Sample Menu Recommendation
Breakfast:
Cold cereal (¾ c unsweetened),
2% milk (½c)
Bread (2 slices) or fried potatoes (1 med potato)
1 fried egg (occasionally)
Lunch:
Bologna sandwich (2 slices white bread, 2 slices bologna, mustard)
Potato chips (1 oz)
1 can Coke
Dinner:
Chopped meat (3 oz beef)
Fried potatoes (1½ medium)
HS Snack: Crackers (6 saltines) and peanut butter (2 tbsp)
Nutrient Analysis: Calories: 2400 , Protein: 89g , Potassium: 1954mg, Sodium:
1600mg, Phosphorus: 1000mg , Fluid: 56oz/1600ml
References for this section:
www.andrew.cmu.edu/~sorensen/
Menu
Breakfast
Rice flakes 2 cup
Whole milk 1 cup
Cranberry juice 16oz
Coffee 8 oz
Bread 2 slices
Jam 2T
Lunch
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2 slices white bread
2 slices turkey
Lettuce
Mustard
Peppers
Soda water with lemon 16 oz
Apple sauce with fresh blueberries 1 cup
Dinner
Chicken 6 oz
Brown rice .75 cup
Green beans 1 cup
Water 8 oz
Salad
Spinach
Iceberg
Peppers
Oil
Vinegar
Snack
Popcorn 3 cup
Iced tea 8 oz
Nutrient Analysis: Calories: 2400 , Protein: 89g , Potassium: 1954mg, Sodium: 1600mg,
Phosphorus: 1000mg , Fluid: 56oz/1600ml
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