HOSA - Medical Nutrition Therapy (Renal Disease)

kidney functions

excretion of waste, maintain volume/composition (fluid, acid, electrolyte), and secrete certain hormones; Done by filtering blood

Nephrons

Unit of the kidney containing a glomerulus; each kidney contains 1 million

glomerulus

filtering unit of the kidney with a network of capillaries that filters blood to form urine.

capillaries

tiny blood vessels connecting veins and arteries

Function of Nephron

To concentrate or dilute filtrate to suit the body’s needs, 180 Liters of ultrafiltrate is made each day

ureters

tubes that transport urine from the kidneys to the bladder, makes around 1.5 L of urine a day

What is in urine

protein waste products, excess water/nutrients, dead renal cells, and toxic substances

end products of protein metabolism (5)

Urea, Uric Acid, Creatinine, Ammonia, and Sulfates

urea

chief nitrogenous waste product of protein metabolism

uric acid

One of the nitrogenous waste products of protein metabolism

Creatinine

an end (waste) product of protein metabolism

oliguria

decreased output of urine to less than 500 ml/day

when kidney cant eliminate nitrogenous waste

renal failure

what makes the final conversion of vit d

kidney

Erythropoietin

A hormone produced by the kidneys that (indirectly) stimulates red blood cell production in the bone marrow.

cysts

growths

renal stones

kidney stones

acute renal failure

suddenly occurring failure of the kidneys; Can be caused by crushing injury, cardiac arrest etc.

what causes kidney disease

infection, degenerative changes, diabetes, high blood pressure, cysts, renal stones or trauma

chronic kidney disease

develop slowly causing the number of nephrons to diminish until kidney loses function

uremia

condition in which protein wastes that should've been excreted are circulate/are built up in the blood

uremia symptoms

nausea, convulsions, headache, coma

dialysis

mechanical filtration of the blood; used when the kidneys are no longer able to perform normally; treatment of severe renal failure

nephritis

general term for inflammatory disease of the kidneys

nephritis causes

infection, degenerative processes, vascular disease

glomerulonephritis

inflammation of the glomeruli capillaries of the kidneys

nephrosclerosis

hardening of renal arteries; caused by arteriosclerosis and hypertension; typically in older people, occasionally young diabetics

polycystic kidney disease

rare hereditary kidney disease causing cysts or growths on the kidney that can ultimately causes kidney failure in middle age

nephrolithiasis

development of stones in the kidney

kidney stone size/location

as small as grain of sand, can be larger, can stay where formed or move around

Symptoms of nephrolithiasis

vary, can be asymptomatic or have blood in urine (hematuria), infection, obstruction, and intense pain (if stones move)

types of kidney stones (5)

calcium oxalate, uric acid, cystine, calcium phosphate, and magnesium ammonium phosphate

cystine

Nonessential Amino Acids

renal disease diet is intended to

To reduce the amount of work demanded of the kidney (slow waste buildup in bloodstream and excretory work) while helping maintain fluid acid and electrolyte balance

Renal disease diet helps control these symptoms:

fluid retention, hyperkalemia, nausea, and vomiting

what does protein do in a renal disease diet

prevent muscle wasting; too much though causes uremia

what is restricted in chronic renal failure (4)

protein, sodium, and maybe potassium and phosphorus

A typical (not overweight) renal client should have how many cal/kg of body weight?

25-50

Where should most of a renal client’s calories come from? Why?

Carbs and fats; to prevent body from using protein/body tissue for energy (causes more nitrogen waste which kidneys must work to remove)

protein limits for predialysis clients

as little as 40g, specific amounts calculated by person’s GFR and weight

Glomerular Filtration Rate (GFR)

The rate at which the kidney filters the blood; amount of protein allowed is based on this

sodium and fluids

are limited to prevent edema, hypertension, and congestive heart failure

phosphorus

limited to prevent osteomalacia

calcium and vitamin D

may be prescribes

renal clients need more

vitamin B, C, and D

vitamin A, K and E

aren’t needed

Vitamin A levels are typically increased in blood w uremia

Vitamin K - unless client is on antibiotics

what tends to occur in end stage renal disease

hyperkalemia

end stage renal disease

The stage at which the kidneys have lost most or all of their ability to function

osteomalacia

softening of the bones due to excessive loss of calcium

excess potassium can cause

cardiac arrest

salt substitutes/low sodium milk

shouldn’t be used because sodium is replaced with potassium

iron is prescribed to alleviate

anemia

hemodiallysis

needs permanent access to the blood stream via fistula

Don 3x a week for 3-5 hours/visit

fistula

unusual openings between two organs; usually near wrist; connect an artery and a vein

peritoneal dialysis

removal of waste products from the blood by injecting the flushing solution into the abdomen and using the clients peritoneum(abdomen lining) as the semipermeable membrane; 10-12 hours a day 3x a week, less efficient

continuous ambulatory peritoneal dialysis (CAPD)

24 hr treatment, changed 4-5 times daily

Protein needs during dialysis

my be increased, but must be monitored to prevent protein waste accumulation between treatments

• Hemodialysis client - 1-1.2 g/kg

• Peritoneal dialysis - 1.2-1.5g/kg

• CAPD 1.2g/kg

• 75% of protein should be from high biological value protein. Ex. eggs, meat, fish, poultry, milk, and cheese

Potassium intake during dialysis

Restricted

• Normal person: 2,000-6,000 mg/day

• Clients in renal failure - 3,000-4,000 mg

• End stage renal disease clients - 1,500-2,500mg/day

• Physician will prescribe necessary amounts to client

Milk during dialysis

restricted to ½ cup per day - because of it’s high potassium and methionine (an essential amino acid)

An excess of which nutrient can compound bone loss in renal clients

phosphorus

typical renal diet

80-3-3

During end stage renal disease

Kidney’s ability to hold sodium and water must be evaluated often

• Usually diet has 3g sodium (basically no added salt diet)

• Sodium and fluids need to increase with sweating, vomiting, fever, and diarrhea

• Fluid content in food is not counted when restricting fluids

• Clients must measure fluid intake and urine output

  • Examin ankles for edema

  • Weigh themselves regularly

Diet after kidney transplant

• Can either need more or less protein

• Carbs/sodium may be restricted depending on medications given

• Extra calcium and phosphorus if thee was substantial bone loss before the transplant

• There may be increased appetite

• Carbs and fats are limited to prevent excess weight gain

Cause of renal stones

not confirmed

general diet for renal stones

lots of fluid (1/2 should be water)

oxalate foods

beets, wheat bran, chocolate, tea, rhubarb, strawberries and spinach

calcium oxalate stones

80% of all stones; caused by diet rich in oxalate; more calcium decreases risk; deficiency in pyridoxine, thiamine, and magnesium contributes

purines

end product of nucleoprotein metabolism

uric acid stones

restrict purine rich foods; associated w gout and gi diseases

purine rich foods

meats; organ meats, anchovies, sardines, alcohol and broths

cystine stones

too much cystine in urine; hereditary metabolic disorder; increase fluid, alkaline ash diet (Fruits, nuts, legumes and vegetables)

struvite stones

aka infection stones bc typically develop after urinary tract infections; made of magnesium ammonium phosphate; low phosphorus diet

hemodialysis

more common; requires permanent access to bloodstream w fistula; cleansing the blood of wastes by circulating the blood through a machine that contains tubing of semipermeable membranes; 3 times a week for 3-5 hours