Kidney Disease p2

How does the Parathyroid Hormone work?

The gland monitors the amount of calcium in the blood and when this gets low, PTH is secreted.

When PTH is released it targets the bones and kidneys

what vitamin controls calcium absorption in the gut?

Vitamin D

When the kidneys aren’t working properly, what happens? Include PTH

1. Serum calcium levels decrease because vitamin D isn’t being activated

2. PTH starts to be constantly produced because serum level are low and body starts to take calcium from the bones

3. Calcium is bound to phosphorous so we also start to lose that

4. This leads to secondary hyperthyroidism bc PTH is constantly being secreted and this leads to bone and mineral disorders

5. Calcification all over the body starts to occur

Hyperparathyroidism

Occurs because PTH is constantly being secreted so parathyroid glands become enlarged and hyperactive

What are the main two types of kidney disease?

Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD)

What are three ways to measure loss of function in kidneys?

Albuminuria

Increased creatinine

Decreased GFR

Cystatin C

Albuminuria

Albumin in urine

Why is Increased creatinine a measure for loss of function?

Bc kidneys are struggling to get rid of it

What is Cystatin C?

A small protein filtered out by the kidney. See if it is increasing because it builds up like creatinine

Define Acute Kidney Injury (AKI)

Sudden drop in function: normally resulting from something else

How can you diagnose an AKI?

Urine output is extremely low

Serum creatinine is very high over the course of 48 hours or 1 week

BUN and Creatnine ratio is 1:1 because increased

Risk factors for AKI?

Older than 75 years old

CKD

Cardiac Failure

Liver disease

Others..

What is AKI classification based off of?

The cause of AKI

Prerenal AKI classification

Result from condition (ex fluid loss, sepsis), not at risk for perishing fast

Intrinsic AKI

Damage within kidneys after a toxin

Postrenal AKI

Caused by obstruction (tumor, stone, clot); more serious

Stages of AKI

Stage 1: at risk for AKI

Stage 2: Injury

Stage 3: Kidney Failure

What is Chronic Kidney Disease (CKD)?

Progresses slowly overtime, can be stable and maintain for years but risk of progressing is high

How do you diagnose CKD?

GFR less than 60 for three months or longer

And or

Albuminuria greater than 30

Risk factors for CKD? Give big 3

Diabetes, hypertension, glomerulonephritis (infection of glomerli in kidneys)

Stages of CKD?

Stage 1: kidney damage, but normal function

Stage 2: kidney damage and mild decrease GFR

Stage 3: moderate decrease GFR

Stage 3A and 3B?

Stage 4: severe decrease GFR (nutritional treatments come into play here)

Stage 5: Kidney Failure

Define Dialysis

Blood is taken from patient, filter through and removes solutes, puts blood back in the patient (Hemodialyis)

Peritoneal Dialysis (PD)

Can do at home, short term fix, injects glucose and pulls out solutes but the glucose stays in the body: risky for patients with diabetes

Continuous Renal Replacement Therapy (CRRT)

Normal dialysis but 18-24 hours and normally used for AKI bc something else is wrong.

How does nutrition play a role in kidney disease

Once GFR less than 60 we see decrease in nutrition status

Plant based diet seems to be best because it doesn’t impact serum levels the way animal protein does

Fluid is still restricted

Renal Diet was debunked because its not about getting the perfect number of things in the diet: everyone is different

How does malnutrition status affect kidney disease

Anorexia because so tired from dialysis

Decreased palatability of food and sometimes has to diet restrict because labs aren’t under control

High Bun alter taste

Protein is lost at 2.5 grams/hour during dialysis

Increased catabolism and decreased anabolism

Complications with Uremic Syndrome

Albumin low

Comorbidity uncommon

No inflammation

Decreased food intake

REE is normal

Protein decreased

Catabolism is reversed by dialysis

Complications associated with MIS

Low albumin

Common comorbidity

Yes inflammation

Low/normal food intake

REE increased

Protein intake increased

Catabolism not reversed by dialysis

How does severe malnutrition occur in chronic kidney disease?

Anorexia from being so tired from dialysis

Loss of protein from dialysis

High BUN alters taste so decreased palattability

How can kidney disease cause calcification?

Calcium and phosphorous are bound together so when PTH is constantly being produced, the calcium is taken from the bones in excess and starts to calcify all over the body such as the heart, legs, wrists

Describe diabetic nephropathy

Hyperglycemia thickens the glomerlues in the kidneys. Blood glucose increases and damages blood vessels in kidneys. This causes internal structures to thicken and harden from all the glucose. Kidneys eventually get destroyed.

Nephrolithisasis aka kidney stones main cause?

Hypercalciruia - excessive calcium in the urine

How are kidney stones created?

Solubility and precipitation imbalance of minerals salts in the urine which creates super concentrated urine and it starts to crystallize

what is the nutritional relevence to kidney stones?

More fluid increases risk

Put on a low oxalate diet

No vitamin C supplements

Types of kidney stones

Calcium, struvite, uric acid, cystine