Renal Disease Flashcards
(12 cards)
What are some of the functions of the kidneys?
- excretion of waste
- homeostasis of fluid and electrolytes
- homeostasis of blood pressure (renin-angiotensin system, ADH)
- acid base balance
- Production of hormones
(erythropoietin and renin) - Vit D activation
What is glomerular filtration rate (GFR)?
What is the normal range?
What is the disease range?
Glomerular filtration rate (GFR) is the rate at which fluid is excreted from the kidneys.
–> Approx 100 ml/min is filtered by the kidneys.
GFR is the best indicator of kidney function.
Normal GFR = 100 or > 90
Kidney disease = < 60
Kidney failure = < 15
What is chronic kidney disease?
- describe the different stages
Long‐term condition that describes abnormal kidney function and/or structure.
- GFR of <60ml/min/1.73m2 present on at least two occasions that are 90 days apart.
- also based on ACR (albumin:creatinine ratio) in urine.
Stage 1
- kidney damage with normal GFR
(eGFR 90+)
Stage 2
- kidney damage with small decrease in GFR
(eGFR 89-60)
Stage 3
- moderate decrease in GFR
(eGFR 59-30)
Stage 4
- severe decrease in GFR
(eGFR 29-15)
Stage 5
- kidney failure
(eGFR <15)
What are the risk factors for CKD?
- Diabetic nephropathy
- High blood pressure
- Obesity
- Nephrotic syndrome
- Heart failure
What are the consequences of CKD?
- Fluid and sodium retention
- Hypertension
- Dyslipidaemia
- CVD (main cause of death)
- High serum K levels (hyperkalaemia)
- Mineral/bone disorders (ospteoporosis)
- Anaemia
- Protein and energy wasting
Describe recommendations for nutritional assessment of CKD
(ABCDEF)
A
- Body weight (dry weight)
- Weight change
- Skinfold callipers may be used (MUAC, TST)
B
- Urea
- Creatinine
- eGFR
- Potassium
- Phosphate
- Serum albumin
- CRP
- PTH
- Urinary protein loss and fluid status
- Serum cholesterol
C
- appetite
- oedema
- co-morbidities
D
- protein and energy intake (24-hr recall , 3-day diet diary)
- foods high in Na, PO, K?
F
- HGS
What is the dietetic management of CKD 1-3?
- Healthy BMI(weight management)
- Protein should not be <0.8g/kg/day
- Normal energy intake (20-25kcal/kg/day) may like to use IDW/ABW.
- Salt <6g/d
- Normal fluid intake unless fluid retention (then consider fluid restriction)
- Normal K intake unless hyperkalaemia
- Normal Phosphate intake as no evidence to support low-phosphate diet in CKD 1-3
What is the dietetic management of CKD 4?
- Maintain a healthy well-balanced diet
- Energy intake 35 Kcal/Kg/d; 30 Kcal/Kg/d for those >60 years
- Monitoring of fluid serum electrolytes levels (severity depends on each patient)
- No added salt advice: 5-6 g
- Low K diet if necessary
- Low P diet (hyperphostaemia is common at this stage)
- If oedema, restrict fluid intake to 500-750 ml in addition to daily urine output
- Protein intake of 0.8g/kg of IBW/day
What is some low K diet advice?
REDUCE INTAKE OF:
Fruits
- banana
- avocado
- dried fruit
Vegetables:
- spinach
- mushroom
- beetroot
- tomato
Potato - chips, baked potato, crisps
Nuts and seeds - soya products
Coffee and malted drinks
Limit milk - 1/2 pint/day
FOOD PREPARATION
- cut veg into small pieces
- after boiling throw water away
What is some low PO diet advice?
REDUCE INTAKE OF:
Meat:
- liver
- ham
(Phosphorus found in animal foods is absorbed more easily than phosphorus found in plant foods)
Fish:
- most shellfish
- sardines
- monkfish
Beans:
- kidney beans
- soya beans
- haricot (baked) beans
Cheese spread/processed cheese
Drinks:
- dark fizzy drinks
- bovril
- malted drinks
What are the nutritional recommendations for patients on HD?
Nutritional supplement (ONS)
Protein ≥ 1.1 – 1.2 g/Kg IBW
Energy 30-35 Kcal/Kg/d
Fluid (500-1000 ml in addition to daily urine output)
Low K diet
Low Na diet
Low P diet
Weight management
Consequences of immunosuppression treatments
(obesity, dyslipidaemia, diabetes, hypertension, mineral and bone disorders)
What is AKI?
AKI (acute kidney injury) is sudden deterioration or loss of kidney function.
Ranges from minor loss of kidney function to complete kidney failure.
Normally occurs as a complication of another serious illness e.g., sepsis, critical illness.
