Causes

Lupus Chronic HTNProlonged Urinary obstruction Nephrotic syndrome PKDCystinosisDiabetes

Lab Evaluation of Kidney Function

Albumin Glomerular Filtration Rate Creatinine BUN Calcium Carbon Dioxide Chloride CBC Glucose Magnesium Phosphorus Potassium

Treatment

Non-Dialysis MNT: Stages 1-2: Focus on Comorbid conditions-DM, HTN,

Hyperlipidemia Stages 3-4 MNT intervention: Renal Diet

HEMODIALYSIS

http://www.kidney.niddk.nih.gov

Peritoneal Dialysis

http://www.kidney-hypertension.com

Medications

Phosphate bindersHematopoietic Growth FactorsIron Products Calcimimietics Statins

Patient Information

Admission 7/16/2013 Chief Complaint:

Shortness of BreathPMH:

Diabetes Aortic insufficiency Chronic Renal

insufficiency Hypothyroidism Hx Breast CA CHF, Unknown Ejection

Fraction HTN

Hyperlipidemia Atrial fibrillation

Past Surgical Hx: Cholecystectomy Lumpectomy Arthroscopy Aortic Valve

Replacement Hysterectomy Rotator Cuff Repair

Social Hx: No smoking, drug, or

alcohol abuse hx

Diagnosis: 7/16/13 Impression

1)SOB, pt increased Lasix dose, pt has worsening Crea 2.7

2)Acute on chronic kidney disease stage IV3)Insulin dependent DM 4)Aortic valve replacement 5)Hypothyroidism 6)Hx of breast CA7)Hx od DVT 8)HTN, controlled9)Hyperlipidemia10) A fib

Diet Hx

7/17 diet hx and patient interview Patient reported “Regular, low sodium low

potassium, low protein” diet. Interview:

NAS Avoid potato and banana Label reading

Assessment

Medi-Tech Note

PES Statement

Altered nutrition related labs related to change in ability to absorb and excrete as evidenced by elevated BUN/Crea, low glucose, CKD Stage IV.

Altered nutrition related lab values related to kidney dysfunction, as evidenced by BUN^ (56) Crea ^ (2.6) , GFR L (19.2), rapid weight changes (4.5# since admission), conditions associated with a diagnosis or treatment related to renal disease.

MNT

Renal/Diabetic Meal Plan Oneonta Renal Disease chart

7/18

Non-productive coughOutput 2.5 L with lasixCrea improvement to 2.3IV lasix to

7/23

“No deterioration in condition” IV Steroids BUN slowly rising (61)Crea decreasing (2.0) D/d within 48 hours

7/23

Teresa’s note! Patient interview Knowledge baseReferral

7/25

“No deterioration in general condition” BUN 71^Crea 2.3 ^ Glucose 268Steriod + glucose Dr. Hongalgi on board

7/26

Discharge!

Care Plan

Interventions Nutrition education

Goals: Pt to follow a renal/carbohydrate consistent diet order

Indicators: Length of stay: 6 days

Monitor

LabsLabsLabsIntake

Evaluation

Were goals met?

Thank you!!!!

Questions?!

Resources

1. Role of a Registered Dietitian in your health care. Cleveland Clinic. http://my.clevelandclinic.org/healthy_living/prevention/hic_the_role_of_a_registered_dietitian_in_your_health_care.aspx. 14 August 2013.

2. Safety and efficacy of drug-eluting stents in older patients with chronic kidney disease," by Thomas T. Tsai, M.D., John C. Messenger, M.D., J. Mathew Brennan, M.D., and others in the Journal of the American College of Cardiology 58(180), pp. 1859-1869, 2011.

3. Nelms M, Sucha K, Lacey K, et al. Nutrition Therapy and Pathophysiology. Belmont, Ca: Wadsworth, Cengage Learning. 2007, 2011.

4. Escott-Stump S. Nutrition and Diagnosis-Related Care. Baltimore, MD. Wolters Kluwer. 2012.

5. "What Is Lupus." Lupus Foundation Of America. N.p., 2013. Web. 14 Aug. 2013. 6. United States Renal Data System. USRDS 2007 Annual Data Report. Bethesda, MD:

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services; 2007.

7. Nickel, M.D., J Curtis. "Urinary Retention." National Institute Of Diabetes And Digestive And Kidney Diseases. N.p., 29 June 2012. Web. 14 Aug. 2013. <http://kidney.niddk.nih.gov/kudiseases/pubs/UrinaryRetention/#complications>.

8. Dugdale, III, David C., and Herbert Y. Lin, PhD, M.D.. "Nephrotic Syndrome." Medline Plus. National Institute Of Health, n.d. Web. 14 Aug. 2013. <http://www.nlm.nih.gov/medlineplus/ency/article/000490.htm>.

9. "Polycystic Kidney Disease- Overview." FamilyDoctor.org. N.p., 01 Jan. 2011. Web. 14 Aug. 2013.http://familydoctor.org/familydoctor/en/diseases-conditions/polycystic-kidney-disease.printerview.all.html

10. "Cystinosis." Genetics Home Reference. U.S. National Library Of Medicine, 01 May 2013. Web. 14 Aug. 2013. <http://ghr.nlm.nih.gov/condition/cystinosis>.

11. Pagana. Manual of Diagnostic and Laboratory Tests. Missouri: Mosby, 2010. Print.

12. Arora, M.D., Pradeep. "Medication Summary." Chronic Kidney Disease Medication. Medscape, 05 Aug. 2013. Web. 16 Aug. 2013. <http://emedicine.medscape.com/article/238798-medication#1>.