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Renal Disease
Kidney functionsThe nephrotic syndromeAcute Renal Disease Chronic Renal Failure Kidney Stones
Kidney Functions
Regulate extracellular fluid volume and osmolarity Regulate electrolyte concentrations Regulate acid-base balance Excrete metabolic waste products like urea and
creatinine and a number of drugs and toxins Help to regulate blood pressure Produce the hormone erythropoietin, which
stimulates the production of red blood cells in the bone marrow
Convert vitamin D to its active form – plays a primary role in calcium regulation and bone formation
The Nephrotic Syndrome: Treatment
Protein and energy– Helps minimize losses of muscle tissue– High-protein diets not advised – can exacerbate urinary protein losses– 0.8 – 1.0 grams of protein per kilogram of body
weight/day– 35 kcalories/kilogram body weight daily – sustains
weight and spares protein– Weight loss or infections–signal the need for additional kcalories
The Nephrotic Syndrome: Treatment
Fat– A diet low in saturated fat, cholesterol, and
refined sugars helps to control elevated blood
lipids
– May need lipid-lowering medications prescribed per physician
The Nephrotic Syndrome: Treatment
Sodium– Sodium restriction helps to control edema– Suggested to limit intake to < 2-3 grams
daily– If diuretics prescribed for edema –
potassium wasting may occur– Encouraged to select foods rich in
potassium
The Nephrotic Syndrome: Treatment
Vitamins and minerals– May require vitamin D and calcium
supplementation – prevent bone loss and rickets
– Multivitamin supplements – prevent additional
nutrient deficiencies
Acute Renal Disease: Consequences
Kidneys become unable to regulate the levels of electrolytes, acid, and nitrogenous wastes in in blood.Urine may be diminished in quantity or absent.Diagnosis – often a complex task.Fluid and electrolyte imbalances
Acute Renal Disease
Goals of nutritional therapy for ARF patients: debilitated:– Minimize uremia (accum. of bld nitrogenwaste
“urea”) and maintain the body’s regular chemical composition
– Preserve the body’s protein stores– Maintain fluid, electrolyte, and acid-base
homeostasis
Nutritional therapy for ARF patients
Protein – Due to catobolic condition associated with
hypermetabolism and muscle wasting – sufficient protein
and energy needed to preserve body’s protein content 0.6g/kg/day in non-dialyzed, non-hypercatabolic patient. With dialysis – protein restricted to 1.2 – 1.3
Calories – 35 kcal/kg of BW/day .
Nutritional therapy for ARF patients
Fluids.– Needed to monitor weight fluctuations, blood pressure,
pulse rates, appearance of skin and mucous membranes
– Daily fluid intake should equal urine output, plus approximately 500ml to replace insensible losses
( the water lost through skin, lungs and perspiration) – Individuals with fever, vomiting, or diarrhea requires
additional fluid– If on dialysis more liberal fluid intake allowed –1.5-2
liters/day
Nutritional therapy for ARF patients Vitamins/Minerals –
Electrolytes must be closely monitored. Potassium and phosphate levels may be elevated. There may also be salt and water imbalances.
With oliguria (abnl production of urine) – sodium intakes limited to 2-3 grams daily
If on dialysis-generally can consume electrolytes more freely Oliguric patients who experience diuresis may need electrolyte
replacement to compensate for urinary losses Some patients need enteral or parenteral nutrition support to
obtain adequate energy (high Kcal Low ptn and electrolytes)
Chronic Renal Failure: Consequences
Generally progresses over many years without causing symptoms
Typically diagnosed late in the course of illness, after most kidney function has been lost
Most common causes :• Diabetes mellitus (43%)
• Hypertension (26%)
Altered electrolytes and hormones Uremic syndrome
Chronic Renal Failure
Goals of nutritional therapy.– Prevent symptoms of uremia while restoring
biochemical balance. – Retard progression of the disease. – Provide adequate calories to maintain or achieve
ideal body weight.
Nutritional therapy for chronic renal failure
Protein – Protein should be restricted to 0.6g/kg/day, with
sufficient essential amino acids. Once dialysis begun – protein restrictions relaxed
• Dialysis removes nitrogenous wastes • Some amino acids –lost during the procedure.
Calories – Calorie intake should be about 35 kcal/kg to maintain
body weight. Foods and beverages of high nutrient density Malnourished patients may require oral formulas or
tube feedings to maintain weight
Nutritional therapy for chronic renal failure
Fat – Restrict saturated fat and cholesterol levels, some renal
patients at risk for coronary heart. Renal diets include high-fat foods to increase calories –
encourage patients to select foods providing mostly monounsaturated fats.
Nutritional therapy for chronic renal failure
Fluids and Sodium – Fluid intake should be based on the patient’s ability to eliminate
fluid Fluid intake should match the daily urine output,if urine output
decreases Fluids – should be restricted Excrete less urine as CRF progresses – can’t handle normal
sodium and fluid intake Monitor total urine output, changes in body weight and blood
pressure and serum sodium levels 2-3 gm/d.adeq., but 1gm/d if the renal failure is severe. Once on dialysis – sodium and fluid intakes controlled so that
water weight gain is 2 pounds between dialysis treatments
Nutritional therapy for chronic renal failure
Potassium – 2 to 3 gms/day should be initiated.
Calcium and Phosphate – supplement calcium and restrict phosphate to 8-12
mg/kg/day.
Vitamins and Mineral- Supplementing folic acid, B6, B-complex, Vitamin D, Vitamin
C necessary. Vitamin A and E not recommended because it may accumulate with renal failure.
Kidney Transplants
Immunosuppressive Drug Therapy
– Side effects of nausea, vomiting, diarrhea, glucose intolerance, altered blood lipids, fluid retention, hypertension and infection
– Increases risk of food borne infection – food safety guidelines discussed with patients and caregivers
– Dietary interventions
Kidney Transplants
Energy: 30-35kcal/kg/d. adjust to maintain reasonable weight. Protein: 1.3-1.5 g/kg/d ,reduced to 1g/kg/d after 6-8 weeks Carbohydrate: consistent CHO intake/d. increase fiber. Fat: Limited saturated fat and cholesterol to help control serum
lipids. Sodium: Restricted (to 2-4g/d ) if fluid retention and hypertension
are present. Potassium: adjust according to serum potassium levels. Calcium: 1000 to 1500 mg to minimize bone loss associated with
drug therapy. Phosphorus: 1200-1500 mg: supplement needed if serum
phosphorus is low. Fluid: No restriction
Kidney Stones
Kidney stone – crystalline mass that forms within the urinary tract . Stone passage can cause severe pain or block the urinary tract.
Formation of kidney stones- 75% of kidney stones – made up primarily of calcium oxalate
Factors that predispose to stone formation:• Dehydration or low urine volume• Renal disease• Urine acidity• Metabolic factors• Calcium oxalate stones• Uric acid stones • Cystine stones • Struvite stones (could be initiated by bacteria forming from
ph)
Kidney Stones: Consequences
Consequences of kidney stones– Renal colic– Urinary tract complications
Kidney Stones: Prevention and treatment of kidney stones
– Diet containing 800 – 1000 mg of calcium per day is recommended because calcium combines with oxalate in the intestines, reducing its absorption and helping to control hyperoxaluria
– Moderate protein and sodium restriction advised
High fluid intakes recommended
hemodialysis
peritoneal dialysis
Thank you!