Renal/Cardiac

Question 1

Clinical signs of CKD

Answer 1

PU/PD
Weight loss

Question 2

What lab abnormalities can be seen with CKD?

Answer 2

Azotemia
Low USG
Elevated UPC (proteinuria)

Question 3

How are MCS and creatinine related?

Answer 3

Creatinine is influenced by muscle mass
If a patient is muscle wasted, creatinine may appear normal

Question 4

What factors might influence BUN?

Answer 4

Increased dietary protein may increase BUN
Liver disease may decrease BUN

Question 5

What is the ultimate nutritional goal with CKD?

Answer 5

Slow the progression of disease by stabilizing serum creatinine and UPC

Question 6

What is one of the most important nutritional factors in managing CKD patients?

Answer 6

Fucking water

Question 7

Protein should be ________ in patients with CKD

Answer 7

Limited

Question 8

How can dietary protein affect CKD patients?

Answer 8

Proteins are broken down into urea, limiting proteins helps control uremic toxins and reduce protein fermentation in the colon

Question 9

When should protein be restricted?

Answer 9

Proteinuria

Question 10

T/F: while protein is limited in cases of CKD, fat is prioritized

Answer 10

True - fat is more energy dense and can be helpful for patients with poor appetite

Energy from fat replaces a portion of protein calories

Question 11

In what cases of CKD might you need to extra cautious when increasing dietary fat with kidney diets?

Answer 11

Pancreatitis
Lymphangiectasia

Question 12

What is the target EPA+DHA for CKD patients?

Answer 12

100-150mg/kg metabolic body weight (BWkg^0.75)

Question 13

Why is it important to restrict phosphorus?

Answer 13

Control hyperparathyroidism and soft tissue calcification

Increased P leads to increased PTH (P excretion, Ca reabsorption). Increased Ca can lead to calcification of tissues

Question 14

When to consider phosphate binders?

Answer 14

When dietary P restriction isn’t working OR patient won’t eat a phosphorus restricted diet

Question 15

Why is it important to include antioxidants in a kidney diet?

Answer 15

Increased free radical generation as fewer nephrons pick up more work
Protects PUFAs from oxidization

Question 16

T/F: Cardiac disease patients need to be on a restricted protein diet

Answer 16

False - do NOT limit protein

Question 17

Taurine is good for cardiac dz b/c can improve ________

Answer 17

Cardiomyocyte contraction

Question 18

Why should L-carnitine be enhanced in patients with cardiac disease?

Answer 18

Shuttles fatty acids across the mitochondrial membrane

Question 19

Why is sodium limitation/restriction important in patients with cardiac disease?

Answer 19

Water retention - especially for those in CHF

Question 20

T/F: In cardiac patients, avoid diets with >2g Na/Mcal, but also don’t want to completely restrict to less than 0.5-0.8g Na/Mcal

Answer 20

True - if sodium is too LOW, renin will be stimulated and RAAS will happen and sodium will be reabsorbed and then water will be reabsorbed and then its just a mess and the heart doesn’t like that

Also food sucks when its not salty

Question 21

What are the main ingredients that have been linked with DCM?

Answer 21

Peas, lentils, legumes, potatoes

Question 22

What is the cause of diet-associated DCM?

Answer 22

We don’t really know, but there are lots of theories

Question 23

A patient presents with DCM and the owner reveals he eats Rachel Ray’s grain free dog food. The owner is keto and its really benefited her, so she figured eliminated grains from her dog’s diet would help him live longer. What is your recommendation?

Answer 23

Stop the diet - switching to a grain-inclusive diet sooner rather than later can improve survival and cardiac parameters

Question 24

DCM patient’s owner really doesn’t want to stop giving Rachel Ray her money, so she keeps him on the same diet. A few months later, he presents in CHF. How has his prognosis changed?

Answer 24

Outcome is worse the longer the grain-free diet was fed so prognosis has greatly worsened