NURS 345 - Nutrition for Diseases of the Kidneys

- controlling ACID-BASE balance

- controlling WATER balance

- maintaining ELECTROLYTE balance

- removing TOXINS and waste products from the body

- controlling BLOOD PRESSURE

- producing the hormone ERYTHROPOIETIN for red blood cell production

- activating vitamin D

*A WET BED

7 functions of the kidney:

- filtering blood by removing excess fluid and more than 200 waste products through the urine

- performing vital metabolic and hormonal functions

the most important bodily functions of the kidneys:

nephrotic syndrome

describes a complex of symptoms that can occur after damage to the capillary walls of the glomerulus

proteinuria, hypoalbuminemia, hyperlipidemia, edema

symptoms of nephrotic syndrome:

glomerulonephritis, nephropathy secondary to amyloidosis, diabetes mellitus, infectious disease, or systemic lupus erythematosus (SLE)

nephrotic syndrome often results from:

- monitor and document body weight

- intake and output must be documented every shift

- educate about foods high in sodium

nursing implications for nephrotic syndrome:

to control hypertension, minimize edema, decrease urinary albumin losses, prevent protein malnutrition and muscle catabolism, supply adequate energy, and slow the progression of renal disease

what are the primary goals of nutrition therapy for nephrotic syndrome?

- consume adequate amounts of protein and energy to prevent malnutrition

- limit total fat

- complex carbohydrates should make up most energy needs

- limit sodium

nutrition therapy for nephrotic syndrome:

sodium

a high dietary _____ intake is detrimental to the nephron

- baking powder

- drinking and cooking water

- medications (e.g., antacids, antibiotics, cough medicines, laxatives, pain relievers, and sedatives)

- mouthwash

- toothpaste

hidden sources of sodium:

acute renal failure

characterized by an abrupt loss of renal function that may or may not be accompanied by oliguria or anuria

- daily weights and intake and output must be documented every shift to help differentiate between fluid shifts and loss of lean body mass

- provide nutrition education that involves reduced protein, sodium, potassium and fluid

- inform the patient that constipation can occur as a result of dietary restrictions, inactivity, medications, and fluid restriction

nursing implications for acute renal failure:

- nonprotein calories should be provided for weight maintenance and to meet the extra demands

- supplement niacin, riboflavin, thiamine, calcium, iron, vitamin B12, and zinc if less than 60 g of protein per day is consumed

- restrict phosphorus

nutrition therapy for acute renal failure:

0.6-0.8 g

if dialysis is not necessary for treatment of acute renal failure, _____ of protein per kg body weight is prescribed

1.0-1.4 g

if dialysis is necessary for treatment of acute renal failure, _____ of protein per kg body weight is prescribed

niacin, riboflavin, thiamine, calcium, iron, vitamin B12, and zinc

in acute renal failure, _____ should be supplemented if less than 60 g of protein per day is consumed

phosphorus

high _____ intake disrupts the hormonal regulation of phosphate, calcium, and vitamin D

restrict sodium and potassium

what is the pattern of sodium and potassium intake during the oliguric phase of acute renal failure?

both sodium and potassium may need to be replaced

what is the pattern of sodium and potassium intake during the diuretic phase of acute renal failure?

urinary volume, serum levels, and frequency of dialysis

during the diuretic phase, both sodium and potassium may need to be replaced, depending on:

restrict fluids to the amount of the patient's output + 500 mL

what is the pattern of fluid intake during the oliguric phase of acute renal failure?

large amounts of fluid may be needed to replace losses

what is the pattern of fluid intake during the diuretic phase of acute renal failure?

chronic kidney disease (CKD)

involves progressive, irreversible loss of kidney function over days, months, or years

glomerulonephritis, nephrosclerosis, obstructive diseases, diabetes mellitus, systemic lupus erythematosus (SLE), and use of illicit drugs

common causes of chronic kidney disease (CKD):

accumulation of nitrogenous waste products and fluid and electrolyte imbalances

chronic kidney disease (CKD) results in:

slowing the progression and minimizing complications

before end-stage renal disease (ESRD) occurs, management of chronic kidney disease focuses on:

reducing uremia (excessive amounts of urea and other nitrogenous waste products in the blood) through conservative management, hemodialysis, peritoneal dialysis, or renal transplantation

once chronic kidney disease reaches end-stage renal disease (ESRD), management centers on:

medical nutrition therapy

a legal term regulated by the federal government that allows Medicare recipients to have "pre-end-stage renal disease" nutrition counseling from a qualified renal dietitian

to slow or prevent the progression to the need for dialysis

what is the goal of medical nutrition therapy in chronic kidney disease?

hemodialysis

during _____, blood is shunted from the patient's body by way of a special vascular access or shunt, thinned with heparin, cleansed of excess fluid and waste products through a semipermeable membrane, and then returned to the patient's circulation

3-6 hours, 3x

the average hemodialysis treatment lasts _____ hours and is usually performed _____x per week

to maintain nutritional status, prevent excessive accumulation of waste products and fluids, and minimize the metabolic effects of ESRD

what is the goal of nutrition therapy for hemodialysis?

saturated

*it is beneficial to use fish oils and olive oil

during hemodialysis, _____ fats should be limited

sodium and fluid, potassium, phosphorus

what should be restricted during hemodialysis?

intradialytic weight gain

sodium and fluid restrictions during hemodialysis should be individualized to minimize _____

5%

the recommended fluid gain between dialysis treatments is less than _____ of the patient's dry (nonedematous) weight

urine output

dietary potassium restriction during hemodialysis varies depending on _____

phosphorus

_____ should be restricted during hemodialysis because high serum levels contribute to hyperparathyroidism and raises calcium levels

milk, milk products, cheese, beef liver, chocolate, nuts, and legumes

foods high in phosphorus:

recombinant erythropoietin (EPO)

given during hemodialysis to treat anemia

iron, vitamin D in its active form, water-soluble vitamins

what should be supplemented during hemodialysis?

water-soluble

patients treated with hemodialysis are at risk for deficiencies of _____ vitamins due to poor intake and loss of the nutrients during dialysis

diabetes

about ⅓ of patients requiring hemodialysis have _____

peritoneal dialysis

removes excess fluid and waste products from the blood by using the peritoneal membrane as filter

peritoneal dialysis can usually be performed at home

what is the advantage of peritoneal dialysis over hemodialysis?

intermittent peritoneal dialysis (IPD)

involves infusion of dialysate over 20-30 minutes, repeated over an 8-10 hour period, 4-5 x per week

to maintain nutritional status, replace albumin, minimize complications of fluid imbalance, minimize symptoms of uremic toxicity, and minimize metabolic disorders

what is the goal of nutrition therapy for peritoneal dialysis?

water-soluble vitamins, daily vitamin supplementation including folic acid and vitamin D, calcium

what should be supplemented during peritoneal dialysis?

protein

*protein losses from peritoneal dialysis range from 20-30 g per day and are reflected in slightly higher dietary protein recommendations

what nutrients should be increased during peritoneal dialysis?

serum BUN and creatinine levels, uremic symptoms, and weight

should be monitored during peritoneal dialysis as indicators of sufficient protein intake

phosphorus

what should be restricted during peritoneal dialysis?

phosphorus

restriction of dietary _____ during peritoneal dialysis is critical to prevent development of osteodystrophy (defective bone development)

osteodystrophy (defective bone development)

restriction of dietary phosphorus during peritoneal dialysis is critical to prevent development of _____

calcium

_____ supplementation is usually prescribed during peritoneal dialysis because restricting dairy products will be necessary to control phosphorus intake

decreased visceral protein stores, low body weight, and deficiencies of vitamin B6, folic acid, vitamin C, vitamin D, and iron are common and should be corrected

nutrition therapy before renal transplantation:

- energy needs in the immediate posttransplantation period are high (30-35 kcal/kg) because of stress from surgery and catabolism

- energy needs decline approximately 6 to 8 weeks after transplantation

- protein should NOT be restricted

- restrict simple carbohydrates with steroid therapy

- limit fats to control hyperlipidemia

- fluids should NOT be restricted

nutrition therapy immediately after renal transplantation and long-term:

steroid therapy

_____ after renal transplantation may cause glucose intolerance and therefore necessitate control of total carbohydrate intake

calcium oxalate (most common), uric acid, struvite, and cystine

types of kidney stones:

- low urine volume

- high urine pH

- excessive urinary excretion of calcium, oxalate, uric acid, or a combination

- decreased levels of substances in the urine that normally inhibit stone formation

formation of kidney stones depends on simultaneous occurrence of:

fluid

all kidney stone treatments require a generous _____ intake

a comprehensive diet history

essential to identify the necessary dietary modifications of kidney stones