Week 11 - Nephrology Flashcards
1
Q
the kidneys receive ____ % of total arterial blood pumped by the heart
A
20-25%
2
Q
an adult’s kidney weighs ____ grams and is the size of ______
A
142 g
size of cellphone
3
Q
Kidneys have higher blood flow compared to the brain and liver
A
4
Q
how many nephrons are there in the body?
A
2 million
5
Q
the nephrons in the body are ______ km long
A
8 km long
6
Q
kidneys pump ____ litres of blood every day
A
1,514 litres
7
Q
they kidneys are _____, which means they are behind the peritoneum
A
retroperitineal
8
Q
the _______ connects the kidneys to the aorta.
the _____ connects the kidneys to the inferior vena cava
A
the renal artery connects the kidneys to the aorta
the renal vein connects the kidneys to the inferior vena cava
9
Q
_______ is the functional unit of the kidneys
A
the nephron
10
Q
_____ conducts urine within each nephron of the kidney
A
loop of henle
11
Q
what is the primary function of the loop of henle?
A
to recover water and NaCl from urine
12
Q
what do loop diuretics, like furosemide, do?
A
they decrease reabsorption of NaCl in the thick ascending limb of the loop of henle
13
Q
what is the main function of bowman’s capsule?
A
it is a double walled chamber for filtering
14
Q
What are the functions of the kidneys?
A
AWETBED
A - regulation of ACID/base balance
W - control fluid or WATER balance
E - maintain ELECTROLYTE balance
T - eliminate TOXINS
B - regulate BLOOD PRESSURE
E - produce ERYTHROPOIETEN, which is secreted by the kidneys
D - activates VITAMIN D and calcium uptake
15
Q
What are the 3 main markers of renal function?
A
- glomerular filtration rate
- blood urea nitrogen (BUN)
- creatinine
16
Q
what is the standard marker to show how much kidney function one has?
A
the GFR
17
Q
how do you calculate the GFT, which is the main marker for kidney function?
A
- creatinine
- age
- body size
- gender
NOT ETHNICITY
18
Q
the kidneys usually filter ____ L/day
A
135-10 L/day
19
Q
what is a normal GFR (which is the main marker of renal function)?
A
90 mL / minute / 1.73m2 BSA
20
Q
____ measures the amount of urea nitrogen, a protein waste product, in the blood
A
blood urea nitrogen (BUN)
21
Q
____ measures how well the kidneys are working by determining the amount of creatinine in the blood
A
creatinine
22
Q
creatinine measures depend on ______
A
amount of muscle tissue
23
Q
who usually has higher creatinine numbers, men or women?
A
men
24
Q
______ is a measure of muscle degeneration and protein waste
A
creatinine
25
what are 3 common types of renal disorders
1. chronic kidney disease (CKD)
2. acute kidney disease (AKD)
3. nephrolithiasis (kidney stones)
26
what is the #1 cause of kidney disease?
diabetes
27
what do the different GFRs indicate?
> 90 mL/min = normal
15-89 mL/min = CKD
< 15 mL/min = end stage renal disease
28
how is one diagnosed with CKD (2 ways)?
1. they have low GFR for 3 months
2. GFR is 15-89 mL/min
29
_____ is the DECLINE in the kidneys ability to:
1. excrete waste products
2. maintain fluid and electrolyte balance
3. produce hormones
while _____ is the kidneys INABILITY to:
1. excrete waste products
2. maintain fluid and electrolyte balance
3. produce hormones
CKD is the decline
end renal stage is the inability
30
what are 4 causes of CKD?
1. diabetes
2. hypertension
3. glomerulonephritis
4. polycystic kidney disease
31
is CKD reversable?
NO! it is an IRREVERSIBLE disease of:
1. glomerular function
2. endocrine function
3. renal function
32
what are the 5 stages of CKD?
stage 1: normal
stage 2: mild loss of function
stage 3: moderate loss of function
stage 4: severe loss of function - weakened bones, anemia
stage 5: kidney failure
33
how do we stop CKD from progressing to stage 5?
1. control blood sugar < 7
2. diet low in:
- protein --> too much protein in urine is big cause of stage 5
- salt
- potassium
- phosphorous
3. medications
34
as kidney disease progresses.....
GFR _______
Creatinine _______
Blood urea ________
GFR decreases
Creatinine increases
blood urea increases
35
what is the main cause of chronic kdieny disease?
diabetic nephropathy
36
what is glomelur nephritis?
responsible for 15% of CKD in younger patients
37
what are 7 main causes of CKD?
1. diabetes.
2. age 60+
3. tobacco use
4. family history
5. obesity
6. heart problems
7. high bp
38
_____ is the buildup of toxins in the blood (secondary to declining kidney function)
uremia
39
what are the signs and symptoms of uremia?
1. high creatinine and BUN
2. malaise
3. weakness
4. nausea and vomitting
5. muscle cramps
6. itching
7. metallic taste
8. neurological impairment
40
_____ % of patients beginning dialysis are malnourished
40%
41
when patients starting dialysis are malnourished, what are the main contributing factors?
1. chronic inflammation
2. anorexia from uremia
3. removal of amino acids, peptides, and proteins during haemodialysis
4. removal of protein during peritoneal dialysis
42
do we lose more protein through haemodialysis or peritoneal dialysis?
peritoneal dialysis
43
what are 4 key aspects of nutritional management for CKD?
1.t vitamin D in the form of calcitriol (and monitor calcium and phosphorous)
2. ensure serum calcium is in normal limits. of not, take supplements
3. need renal specific water soluble vitamins
4. take iron supplement (erythropoietin stimulating agent)
44
What are the main medications in CKD?
1. ACE inhibitors (prils)
2. loop diuretics (semide)
3. dyslipedmia medications (statins)
4. anticoagulants (arin)
5. vitamins
6. corticosteroids - IN TRANSPLANT POPULATIONS
7. diabetic management
8. anemia management
9. constipation management
45
what are the 3 options for renal replacement therapy?
1. transplant
2. haemodialysis
3. peritoneal dialysis
46
what are the 3 types of schedules for haemodialysis?
1. conventional - 2.5-4 hrs, 3x per week
2. daily schedule - 2 hrs, 6-7x per week
3. nocturnal schedule - 6 hrs per night, every night
47
when one gets a kidney transplant, where is the donor kidney placed?
in the lower abdomen
48
What are the differences between PD and and HD?
PD
- not as common, because self management is intimidating
- not as efficient in removing solutes and water from the body
Patients can:
- remain ambulatory
- provide their own care
- have fewer dietary restrictions
weight gain
removes less phosphorous than HD
49
what are some long term complications of dialysis?
1. anemia
2. coagulopathy - excessive bleeding or clotting
3. dyslipedmia
4. malnutrition
5. weight gain (PD) or weight loss (HD)
50
PD leads to weight ____ while HD leads to weight _____
PD leads to weight gain while HD leads to weight loss
51
we usually want hemoglobin levels to be _____
for CKD/dialysis, hemoglobin levels are _____
want them to be 130
they are 100-120
52
albumin levels during CKD
35-50
53
when on dialysis, we want calcium lebels to be lower to protect bones
54
what is the role of the renal dietitian?
1. assess the big picture / medical history
2. counsel / reocmmend
3. develop / modify plan of care
55
how much sodium should people with CKD eat per day?
2000 mg/day
56
why do we want to restrict sodium with CKD? it helps manage:
1. excessive thirst
2. edema
3. hypertension
4. CHF
57
what are various nutrients you need to control with CKD? (stage 3 or later)
1. energy = 25-35 kcal / IBW
2. protein 0.6-0.8 g/kg IBW
3. sodium - 2000 mg/day
4. phosphorous - 0.8-1g/day
5. potassium - 2000 mg/day - 4000 mg/day
6. fluids - unrestricted
58
what are various nutrients you need to control for end stage renal disease on haemodialysis?
1. energy = 25-40 kcal dry weight
2. protein 0.9-1 g/kg dry weight
3. sodium - 3000 mg/day
4. phosphorous - 0.8-1g/day
5. potassium - 2000 mg/day
6. fluids - 1000 mL/d + urine output
59
what are various nutrients you need to control for end stage renal disease on peritoneal dialysis?
1. energy = 25-35 kcal dry weight
2. protein = 1-1.3 g/kg dry weight
3. sodium - 3000 mg/day
4. phosphorous - 0.8-1g/day
5. potassium - individualized
6. fluids - individualized
60
CaCO3, Tums, renagel, and fosregnol are:
phosphorous binders
61
why do we need to achieve normal serum phosphate with CKD? to prevent:
1. hyperphosphatemia
2. secondary hyperparathyroidism
3. renal osteodystrophy
62
do we stillneed to restrict phosphorous in CKD if serum phosphorous and PTH levels are normal?
yes - but focus onr estricting inorganic phosphorous
63
what are signs and symptoms of secondary hyperparathyroidism in cKD patients?
disabling bone pain
fractures/bone deformaties
bone cysts
ostweopenia
64
CKD leads to less phosphorous leaving body, leads to more phosphorous and FGF in blood, leads to decreased vitamin D and calcium --> secondary hyperparathyroidism
65
how to treat secondary hyperparathyroidism?
restrict INORGANIC phosphorous to 0.8-1g/day per day
take phsophate binders
vitamin D analogue
66
what are the treatments for secondary parathyroidism?
1. medical nutrition therapy (restriction to 0.8-1 g of inorganic phosphorous/day)
2. medication
3. dialysis
4. surgery - parathyroidectomy
67
when do you resort to a parathyroidectomy for secondary parathyrodisim?
if pth levels are > 88 pmol/L
if hypercalcemia
if disabling bone pains
68
why is it better to have prganic phosphorous than inorganic phosphorous?
because with inorganic phosphorous, 100% of it is absorbed
69
what happens if yo udont restrict phosphorous in CKD? what happens if you do restrict phosphorous?
calcification
adynamic bone disease
MBD (mineral and bone disease)
if you do restrict:
- malnutrition from inadequate protein
70
what is renal osteodystrophy
a complication of chronic kidney disease that weakens your bones.
as GFR decreases, less phosphorous is excreted. high serum phosphorous = low serum calcium.
high phosphorous + low calcium = PTH synthesis and secretion --> DECREASED VITAMIN D CONVERSION = bone problems
71
if people have transplant, do they need high or low phosphorous diet?
high phosphorous diet
72
nuts, chocolate, processed foods, dairy, are all sources of:
phosphorous
73
restriction of phosphorous prevents:
1. bone decalcification
2. soft tissue calcification
3. secondary hyperparathyroidism
4. itchy skin
74
how much phosphorous from chocolate, nuts, legumes gets absorbed?
10-30%
75
how much phosphorous from whole grains, brown rice, meat get absorbed?
40-60%
76
list the order of phosphorous content from high to low:
chicken breast
white break
milk
almonds
milk > almonds > white bread > chicken breast
77
boiling foods helps remove _____
phosphorous
78
proteins are high in phosphorous
79
what 4 foods to include in phosphorous restricted diets?
1. fresh or frozen meat and fish
2. limited cheese
3. limited milk
4. whole grain
80
people who have impaired renal function and hyperkalemia may need a potassium restricted diet
81
people on which medications need a potassium restricted diet?
ACE inhibitors
angiotensin receptor blockers
82
restriction of ______ helps prevent cardiac arrhythmias
potassium
83
high potassium foods include:
bananas
avocados
orange
potato
squash
Low potassium foods: apple, pineapple, berries
84
Which 4 foods should we avoid because of excess potassium
starfruit
potato - double boil
sweet potato - double boil
yam - double boil
85
when should you restrict fluids in CKD/ESRD?
1. patients with edema
2. patients with congestive heart failure
3. uncontrolled hypertension
86
examples of fluid output include:
1. urine and stool
2. insensible loss
3. sweating
4. fever
5. wound
6. diuretics
87
fluid intake includes anything liquid at body temp. this includes:
ice
gelatin
popsicles
soup
ice cream
88
5 tips to control thirst
1. avoid salty foods
2. swallow pills with food
3. use small cups
4. sip fluid slowly
5. eat frozen fruit
89
_____ is the abrupt decline iN GFG, USUALLY REVERSIBLE. cant maintain fluid, electrolyte, and acid-base balance
acute kidney injury
90
is acute kidney injury reversible?
usually
91
how do we diagnose AKI?
1. creatinine increased by 26 mmol/l in 48 hours
2. creatinine increased by 1.5x in past week
3. urine output < 0.5 mL/kg/hr for MORE THAN 6 HOURS
92
who gets AKI?
people in hospital, on drugs, chemo, MRI scan medication
93
what are 5 main causes of AKI?
1. severe dehydration
2. fluid losses from burns
3. exposure to toxins
4. systemic inflammatory conditions like sepsis
94
what is olguria?
< 500 ml of urine output per day
95
what are clinical manifestations of AKI?
< 500 ml urine output
hypercatabolic - increased potassium, magnesium, phosphorous (but can also be low)
increased BUN and creatinine
96
_____ is the imbalance between solubility and precipitation of mineral salts in the urine, resulting in supersaturation
nephrolithiasis (kidney stones)
97
what are risk factors for nephrolithiasis?
1. family history
2. low urine output
3. gout
4. excess vitamin D or calcium intake
5. UTIs
98
what are the signs and symptoms of nephrolithiasis?
NONE until stone is moved into ureter
99
how do you diagnose nephrolithiasis?
1. intravenous pyelogram
2. x-ray
3. renal ultrasound
4. analysis of urine
100
if the stone cant be passed, how d you treat it?
1. extracorporeal shock wave lithotripsy (EWSL)
2. percutaneous nephrolithotomy
3. ureterorenoscopy and extraction
101
nutrition therapy in kidney stones - things to look out for:
1. balanced ph
2. lots of hydration - 2.5 L
3. enough calcium - 1000 - 1200 mg/day
4. low oxalate - restrict to 100 mg/day
5. low uric acid
6. low sodium
7. high citrate through fruit and veggies
limit vitamin C to 1000 mg
avoid excess protein - 0.8 to 1 g/kg
reduce purine foods
102
what is an apprporiate PES statement relation to kidney stones?
1. EXCESSIVE MINERAL INTAKE
2. INADEQUATE FLUID INTAKE
3. NUTRITION RELATED KNOWLEDGE DEFICIT
