RENAL DIET

hypertensive nephrosclerosis

#3rd CKD cause

kidney

Bean-shaped organs, each about the size of a fist.

work as fine-tuned internal sensors that balance the amount of fluid in your body, detect waste in your blood, and know when to release the vitamins, minerals, and hormones you need to stay alive.

main goal: to dispose of waste products and to turn them into urine

Help the body maintain chemical fluid, and acid-base balances and assist in blood pressure regulation, red blood cell production, and the activation of vitamin D.

180 L

the kidney Process about __ of blood daily.

1.5-2 L

the kidney sifts out about ___ of waste products and water

Glomerulus

ball-shaped tuft of capillaries ○ blood filtration

works like a sieve, allowing only certain ingredients such as vitamins and minerals to pass into the tubule.

Then, this vessel’s job is to detect whether any of those ingredients are needed in the body. If so, they are reabsorbed in amounts that the body needs, so they can circulate in the blood again.

a network of thin-walled capilaries closely surrounded by a pear-shaped epithelial membrane calledBowman’s capsule (within the kidney)

Proximal tubule

various substances are actively or passively reabsorbed, secreted, or metabolized

Distal tubule and loop of henle

Secretion of potassium and hydrogen ions, and the regulation of water

for minerals

Medulla

urine concentration

ureter

Conducts urine from the kidneys to the bladder.

bladder

Stores urine until it can be excreted.

renal artery

Carries blood from the heart to the kidneys

renal vein

Carries blood from the kidneys back to the heart.

acid-base balance, water balance, electrolyte balance, toxin removal, blood pressure control, erythropoietin production, vitamin D metabolism

primary function of kidneys

A WET BED

anasarca

edema from head to feet

Glomerular Filtration

Glomerolus act as sieve to filter the blood

Tubular Reabsorption

Wanted substances will be reabsorbed (like H, potassium)

Tubular Secretion

Unwanted waste will go to ureter and stored in the bladder, secreted out in through the urethra

Azotemia

signs and symptoms: too much waste

a buildup of nitrogenous waste products such as urea in the blood and body fluids

Oliguria

signs and symptoms: less urination

That is why there is fluid retention; if there is impaired function, then the urine will not be released.

daily urine output of <500 mL which is the minimum amout of normal urine that can carry away the daily load of metabolic waste products

hyperkalemia

signs and symptoms: too much K in the blood

metabolic acidosis

signs and symptoms (H ions) (due to H & Bicarbonate balance)

Imbalance of Hydrogen and bicarbonate ○ May also be due to too much K

Renal osteodystrophy

signs and symptoms: (Ca imbalance; too low Ca)

a general term that referes to bone disease related to CKD and cased by over or underproduction of parathyroid hormone or by exposure to aluminum

Secondary parathyroidism

signs and symptoms (due to inc. in PTH)

high circulating levels of parathyroid hormone that stimulate bone turnover, which may be accompanied by hyperplasia of the parathyroid glands

albumin

markers to check for malnutrition

if very low or is secreted in the urine, it could be edema

polyuria

frequent urination

anuria

no urination

Renal osteodystrophy

Most renal patients, especially CKD stages 3-5, have weaker bones

1+ edema

2 mm or less indentation

Disappear rapidly

Mild pitting edema

2+ edema

2-4 mm indentation

15 seconds to rebound

Moderate pitting edema

3+

4-6 mm indentation

30 seconds to rebound

Moderately severe pitting edema

4+ edema

6-8 mm indentation

>60 seconds to rebound

Severe pitting edema

albuminuria

leaking of small amounts of albumin.

● First sign of renal insufficiency

a1 albuminuria

ACR: <30 mg/g

Normal to mildly increased

a2 albuminuria

ACR: 30-300 mg/g

moderately increased

microalbuminuria

a3 albuminuria

ACR: >300 mg/g

severly increased

macroalbuminuria

Albumin-to-creatinine ratio

the first method of preference to detect elevated protein.

● The recommended method to evaluate albuminuria is to measure urinary ____ in a spot urine sample.

is calculated by dividing albumin concentration in milligrams by creatinine concentration in grams.

Nephrotic syndrome

too much albumin in the kidney

Is not a disease but a distinct cluster of symptoms caused by damage to the glomerular capillaries

● The damage alters the permeability of the glomerular capillaries and allows plasma proteins to escape in the urine (proteinuria)

a clinical condition consisting of losses of protein in the urine exceeding 3.5 g/day, hyperlipidemia, and low albumin levels (<3.5 g/dL) with edema

glomerular filtration rate

measures kidney function

Reflected in clearance tests that measure the rate at which substances are cleared from the plasma by the glomeruli.

Used to evaluate kidney health, estimate the severity of disease and monitor disease progression

the filtration ability of the glmerulus; used as an index of kidney function; normal value is approximately 125 ml/min

Chronic Kidney disease

defined as either kidney damage or GFR <60 mL/min/1.73m^2 for 3 months or longer

Progressive loss of kidney function (50-70%)

● Irreversible loss of excretory, endocrine and metabolic function. ● Etiology ○ DM ○ Hypertension ○ Glomerulonephritis ○ Neoplasm

● Early __ has no signs or symptoms

● A person can lose up to 90% of their kidney functions before experiencing any symptoms

Kidney damage

is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies.

stage 1 ckd

Kidney damage with normal or increased GFR

≥ 90 mL/min/1.73m2 GFR

Diagnosis and treatment

Treatment of comorbid conditions

Slowing progression

CVD risk reduction

stage 2 ckd

Kidney damage with decrease in GFR

60-89 mL/min/1.73m2 GFR

Estimating progression

stage 3 ckd

Moderate decrease in GFR

30-59 mL/min/1.73m2 GFR

Evaluating and treating complications

stage 4 ckd

Severe decrease in GFR

15-29 mL/min/1.73m2 GFR

Preparation for kidney replacement therapy

stage 5 ckd

Kidney Failure

<15 mL/min/1.73m2 GFR (dialysis)

Replacement (if uremia present)

Serum Creatinine

as kidney function decreases, levels start to increase

● Cannot be used to measure GFR

>1.2 mg/dL; >1.4 mg/dL

serum creatinine: Sign of Kidney Disease for men and women

Blood Urea Nitrogen

from protein breakdown

● Decreased kidney function: increase ___ level

dietary related

7-20 mg/dL

normal BUN range

ultrasound

uses sound waves to get a picture of the kidney.

● Used to look for abnormalities in size or position of the kidneys or for obstructions such as stones or tumors.

Computed Tomography Scan

imaging technique uses X-rays to picture the kidneys.

● May also be used to look for structural abnormalities and the presence of obstructions.

● May require the use of intravenous dye which can be of concern ofr those with kidney disease.

Contrast Induced Nephropathy

Mainly caused by the CT scan with the use of the dye.

● Risk Factors

○ Pre-existing CKD

○ Heart/blood vessel problem ○ Old age

Nephrogenic Systemic Fibrosis

● Mainly caused by the MRI with contrast dye.

urinalysis

can help detect a variety of kidney and urinary tract disorders, including chronic kidney disease, diabetes, bladder infections and kidney stones.

urine protein

to detect presence of excess amount of protein in the urine (+)

nephrolithiasis

The most common disorders that affect the kidneys and urinary tract.

Develop when stones constituents become concentrated in the urine and form crystals that grow.

Characterized by frequent occurences between the ages 30 to 50.

Predominance in males (3x more often).

The risk doubles with a family history of kidney stones.

Calcium stones

nephrolithiasis: hypercalciuria ○ Excess Na and protein can increase Ca loss

uric acid stones

nephrolithiasis: gout

Acid-Ash Diet

Diet with increased sources of acid forming foods (sulfur, phosphorus, chloride) such as meat, fish, eggs and cereals while restricting the intake of alkaline-forming foods.

To bring about a reduction in the pH of urine which favors excretion of kidney stones (calcium, magnesium, phosphate and oxalate kidney stones)

Alkaline-Ash Diet

Diet with increased intake of alkaline forming foods (Na, K, Mg, Ca) such as fruits, vegetables and milk while limiting the intake of acid forming foods.

To bring about an increase in the pH of urine (uric acid and cystine stones)

urinary tract infection and pyelonephritis

Caused by E. coli, other organisms found in complicated infections associated with DM, urinary stones and immunosuppression.

Result from obstruction or injury

Characterized by inflammation of the bladder and/or kidneys*, flank pain and fever for (p_____)

Hypoalbuminemia, Hypercoagulability, Abnormal bone metabolism, Proteinuria, Anasarca

signs and symptoms of nephrotic syndrome

acute glomerulonephritis

Active inflammation in the glomeruli

● an immunologic response to an infection (usually streptococcal) which damages the glomeruli.

● Most common in children

● Signs and symptoms

○ Hematuria

○ Hypertension

○ Mild loss of renal function

■ capillary inflammation damages glomerular barrier to the blood

chronic glomerulonephritis

Is caused by slow progressive destruction of the glomeruli of the kidney with progressive lost of kidney function

● Advance stage of a group of kidney disorders, resulting in inflammation and gradual, progressive destruction of the glomeruli

● Causes: DM, HTN, cancer, strep or viral infections, NSAIDs, Lupus

● Signs: proteinuria, blood in the urine, high blood pressure, anemia

acute renal failure

Abrupt, short-term loss of kidney function ○ Reversible

Caused by toxic injury to the liver, severe hemorrhage, after burns, injuries, shock, transfusions, antibiotics, sepsis ● Sudden reduction in GFR (rapid, reversible)

● Characterized by fluid and electrolyte imbalances and muscle wasting

chronic renal failure

Progressive worsening of kidney function

○ irreversible , requires dialysis or transplantation

uremia

Constellation of symptoms of kidney failure

○ Malaise, weakness, nausea, and vomiting, muscle cramps, itching, metallic taste (nitrogenous wastes)

a general term used to encompass a cluster of symptoms resulting from disordered biochemical processes as chronic kidney disease progresses; early symptoms include fatigue, delayed thinking, and pruritis

Pruritus

medical term for itching

○ Itching is due to the toxin buildup ○ As when the skin is exposed to chemicals it causes itchiness

○ The difference is it is internal. Not touched but is inside and cannot be excreted.

Prerenal ARF

● Hyperfused kidneys

● Develops with the impairment/reduce in blood flow [burns, hemorrhage, hypovolemia, cardiac shock)

● Results to decreased urine output and retention of N bases

Postrenal ARF

ARF CATEGORY

● Results from obstruction of urine flow (bladder, cancer, prostatic hyperplasia, blood clots)

Intraternal/Intrinsic ARF

ARF CATEGORY

● Actual damage to the kidneys parenchyma

● Etiology: GN, SLE, pre-renal ischemia, MOF

anuric

ARF phase

● Reduction in glomerular filtration rate (GFR).

● <100 mL urine

● Aggressive dialysis

● 10-14 days

Oliguric

ARF phase

● Reduction in glomerular filtration rate (GFR)

● <400/500 ml urine

● BUN rises (azotemia)

● Metabolic acidosis (phosphate)

● Hyperkalemia (result of tissue catabolism

● 8-14 days

Diuretic

ARF phase

● Increase in urine volume (150-200%)

● Unable to produce concentrated urine

● Risk for dehydration

● Electrolyte imbalance: (K, Na, BUN) related to hydration and urine concentration ability

● 10 days

Convalescent

ARF phase

● Renal function normalizes

● Laboratory value stabilizes ‘

● 4-6 months

acute kidney injury

refers to any deterioration in kidney function that happens in less than three months.

refers to kidney dysfunction of short duration aor any sudden, severe impairment of kidney function

diabetes

The most common cause of CKD is ___, excess glucose in the blood starts sticking to proteins in the blood — a process called non-enzymatic glycation because no enzymes are involved.

asterixis

As the toxin levels really build up, they can affect the functioning of the central nervous system - causing encephalopathy. ○ This results in ____, a tremor of the hand that kind of resembles a bird flapping its wings and is best seen when the person attempts to extend their wrists.

end stage renal disease

Condition of total or nearly total and permanent kidney failure

● It is the stage of kidney damage when kidney function is reduced to approximately 10 to 15% of normal

● When 85 to 90% of function has been lost and some form of renal replacement therapy is needed to maintain life.

ckd stage 5 or when a patient requires renal replacement therapy

dialysate

rising fluid

fluid used by the dialysis procedure to assist in removal of metablic byproducts, wastes, and toxins; composition is determined by individual patient requirements

hemodialysis

Fistula

○ one time surgical procedure

○ Process of diffusion and convection will occur

○ Short period of time ■ 2-3 hours ■ 3 times a week

cleans and filters the blood using a machine to temporarily rid the body of harmful waste, extra salt, and water. ● 12 hours/week ● 3-4 hour session

a type of rneal replacement therapy whereby wastes or uremic toxins are filtered from the blood by a semipermeable memberane and removed by the dialysis fluid

Peritoneal dialysis

surgical procedure on the peritoneum or the abdominal cavity ○ Slower progression ■ Longer period of time ■ Some are overnight

This type of dialysis uses the lining of the abdomen to filter blood. ● This lining is called the peritoneal membrane and acts as artificial kidney.

continuous renal replacement therapy

type of renal replacement therapy used to treat patients with acute kidney injury particularly those with multiple organ failure; the types of patients treated tend to be hemodynamically unstable, have poor cardiac output and unable to tolerate hemodialysis Lower rate of fluid removal

continuous ambulatory peritoneal dialysis

2 to 3 L of dialysate 4-5x each day with dwell times of 4-6H

continuous cycling peritoneal dialysis

uses a cycling machine that automatically fills and drains the patient’s abdomen of dialysate usually over the nighttime while the patient sleeps

kidney transplantation

surgically places a healthy kidney from another person into the body of patients with end-stage kidney disease.

the donated kidneys does the work that the two failed kidneys used to do.

cystine

a sulfur containing amino acid that is produced by the actions of acids on proteins that contain this compound

dialysis

renal replacement procedure that removes excessive and toxic byproducts of metabolism from the blood, thus replacing the filtering function of healthy kidneys

hypercalciuria

an excess of calcium in the urine

hyperoxaluria

an excess of oxalate in the urine

hyperuricosuria

a disorder of uric acid metabolism

microalbuminuria

leaking of small amounts of albumin into the urine by the kidneys

nephron

basic functional unit of the normal kidney; each___ has two main parts: the glomerulus and the tubule

oxalate

a salt of oxalic acid produced by the body’s metabolism and excreted in the urine

proteinuria

the presence of too much protein the urine

struvite

a form of kidney stone scomposed of amonium and magnesium phosphate; resemple hard crystals

tubules

component of the nephron responsible for reabsorption and secretion within the kidney; designated as the proximal convoluted ___; the loop of Henle, and the distal convoluted __

uric acid

a crystalline acid formed as an end [roduct of purine metabolism; a commmon stituent of renal calculi