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75 Cards in this Set
- Front
- Back
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Nephrons |
the structural and functional unit of the kidney, consisting of a glomerulus connected to various tubules |
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Glomerulus |
a spherical mass of capillaries surrounded by a thing wall called Bowman's capsule. The glomerulus ultra filtrates blood. In order to function properly, pressure between the heart and renal artery must be "normal." |
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tubules in the glomerulus |
produce urine final urine to collecting tubules to renal pelvis to ureter to bladder |
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Solute Load |
waste products from metabolism that are filtered via the kidney. Most of the waste products are nitrogenous waste from PRO degradation. |
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Renal Function |
Excretory Metabolic Endocrine |
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Excretory |
Filtration blood filtered through glomerulus Reabsorption selective process Secretion H ions, K secreted into tubule |
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Metabolic Function |
Acid/Base balance normal arterial blood pH is 7.4 alkalosis over 7.4 acidosis uncer 7.4 carbonic anhyrase |
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Special Control Systems of acid/base |
buffer system respiratory center kidneys |
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Endocrine Function |
-renin angiotensin mechanism (Na/H20 reabsorbed, vasoconstriction, BP maintained) -erythopoietin production of hemopoietic stem cells, proerythocytes, RBC, Tissue Oxygenation -ca-pho homeostasis via production of vit D vasopressin (fluid low and osmolality high resorption of H20) |
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SIADH syndrome of inappropriate antidiuretic hormone secretion |
increases vasopressin hyponatremia excessive fluid retention |
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Diabetes Insipidus |
insufficient vasporessin increase VO dehydration hypotension hypernatremia |
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Kidneys |
maintain homeostatic balances of fluids, electrolytes, and organic solutes kidneys produce erythropoietin (increase RBC) maintain calcium-phosphorous homeostasis renin-angiotensin mechanism for BP |
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azotemia |
high levels of nitrogen-containing compounds (such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds) in the blood |
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Uremia |
urea in the blood azotemia w/ sx |
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oliguria |
production of low amounts of urine |
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anuria |
no urine |
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renal dz excretory |
increase waste products |
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renal dz matabolic: a/b balance |
H+ not excreted, acidosis |
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renal dz Endocrine |
BP/Fluid Status |
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renal dz Renin |
increase sodium/water retention |
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renal dz vasopressin |
anemia |
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renal dz EPO |
decrease production |
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renal dz 1,25 D3 |
ca/phos imbalance, bone dz |
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Disease progression to ESRD |
HTN DM Glomeruolonephritis |
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Glomerular Dz |
nephrotic syndrome nephritic syndrome |
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Diseases of tubules and interstitium |
ARF Pyelonephritis |
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Nephrotic Syndrome |
proteinuria second to increased glomerular permeability leads to hypoalbuminemia, edema, hypercholesterolemia, hyper coagulability, and abnormal bone metabolism often caused by DM, Lupus, amyloidosis, and dz of the kidney muscle wasting is common |
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MNT: Nephrotic Syndrome |
Manage sx, prevent progression to renal failure PRO .8-1.0 Kacls 35 (unless obese) Na 1-2g/day P less than are = to 12 mg/kg/day Ca to low alb Fluid output + 1000 ml Vit/Min DRI B complex and C |
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Nephritic Syndrome |
also called acute glomerulonephritis inflammation of the capillary loops in the glomerulus usually an acute dz but may lead to further kidney problems characterized by hematuria (blood in urine) |
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MNT: nephritic Syndrome |
maintain desirable nutritional status no reason to restrict PRO or potassium unless labs warrant or uremia develops |
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Acute Renal Failure |
Sudden reduction in glomerular filtration rate alteration in the ability for the kidney to remove biologic waste usually occurs when the body is under severe stress, like trauma or burns or from drug toxicity |
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ARF |
kidneys become unable to regulate the levels of electrolytes, acid, and nitrogenous waste in blood urine may be diminished in quantity or absent |
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ARF Fluid and electrolyte imbalances |
edema (anuria or oliguria) sodium retention Hyperkalemia (elevated K in blood) can alter heart rate and lead to heart failure Hyperphophatemia can increase secretion of parathyroid hormones and reduce blood calcium levels |
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ARF Uremia |
accumulation of the body's nitrogen-containing waste products blood urea nitrogen (BUN), creatinine, and uric acid Catabolic state produces more N wastes Sx: fatigue, lethargy, confusion, headache, anorexia, metal taste, N/V/D, BP increase, coma |
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MNT:ARF |
PRO .6-.8 Kcals 35-50 Na 1-2g/day K 2 g/day P maintain serum value WNL Ca WNL, and low alb Fluid output + 500 ml Vit/Min DRI |
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Pyelonephritis |
infection of kidney and ducts that carry urine UTI : back flow into ureters Cranberry Juice Encourage Fluids |
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Nephrolithiasis different types |
calcium oxalate and calcium phosphate stones
uric acid stones cystinine stones struvite stones |
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Calcium Oxalate and Calcium phosphate stones |
most kidney stones common in middle-aged men calcium restriction not recommended may cause stones, and excessive PRO intake limit PRO to RDA high Na intake leads to increase Ca excretion in urine |
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Chronic Kidney Dz |
includes conditions that affect the kidney, with the potential to cause either progressive loss of kidney function or complications resulting from decreased kidney function. It is the presence of kidney damage or decreased level of kidney function for 3 months or more, irrespective of dx |
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CKD criteria |
for longer or equal to 3 monte, as defined by structural or functional abnormalities of the kidney, with or w/o decreased GFR, manifest by pathological abnormalities or makers of kidney damage, including abnormalities in the compose tion of the blood or urine, imaging test GFR decrease 60 mL/min/1.73 & declines with age; half or more of kidney function |
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CKD etiology |
DM is #1 cause followed by HTN CKD leads to CVD and other co morbid complications |
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CKD complications Altered electrolytes and hormones |
Usually develops during the final stage of renal failure hormonal adaptations occur to help regulate electrolyte levels increased secretion of PTH keeps serum P levels normal, but bone loss (renal osteodystrophy) |
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CKD complications Uremic Syndrome |
Develops during the final stages of CKD GFR less than 15 mL/per min BUN less than 60 mg/dL Subtle mental dysfunctions Neuromuscular changes Impaired erythropoietin synthesis anemia defects in platelet function and clotting factors |
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CKD complications Uremic Syndrom PRO-energy malnutrition |
Anorexia: believed to be a primary cause of poor food intake secondary to n/v, restrictive diet, uremia, and meds Nutrient losses: consequence of V, D, GI bleeding concurrent catabolic dz and dialysis |
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CKD Complications CVD risk |
hypertension, increased insulin resistance and abnormal lipids, elevated PTH levels lead to calcification of blood vessels and heart tissue decrease immunity develop infections |
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CKD stages |
stage 1-4 no dialysis stage 5 dialysis |
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Goals of nutrition tx for CKD |
retard or stop progression of renal failure maintain optimal nutritional status minimize toxicity and metabolic derangements |
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Slowing the progression of CKD |
treat underlying condition (SLE, vasculitis, glomerulonephritis) BP control, Reducing proteinuria, controlling DM, controlling excess weight, exercising, controlling lipids, no smoking, avoiding drugs known to damage the kidneys |
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MNT: CKD stage 1-4 |
PRO .6-.75 (50% HBV) Kcals 30-35 Na 2000 mg/day K usually unrestricted P 10-12 mg/kg/ day Ca 1200 mg/day Fluid no restriction |
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Lipids and CKD |
pts are considered at hight risk for CVD emphasis on restricting sat fat to less than 10% favor MUFA and PUFA 250-300 mg cholesterol |
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V & M ESRD |
Vit C 60-100 B6 2 Folate 1 B12 3 Vit E 15 Zn 15 B1 1.5-2.0 usually prescribed nephrocaps and nephrovite |
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ESRD |
kidneys are unable to excrete waste, maintain fluid balance, maintain e-lyres balance and produce hormones causes uremia due to hight levels of N waste in blood weakness, malaise, N/V, neurologic impairment Dx by BUN less than 100 mg/dL & Cr 10-12 |
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Tx of ESRD |
two options transplantation dialysis HD CAPD CCPD |
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Dialysis Diffusion |
small molecules (electrolytes and waste products) move from an area of high concentration to low
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Dialysis Osmosis |
high water concentration to low water concentration (more solutes) |
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Dialysis Ultrafiltration |
pressure squeezes water and small molecules through the pores of a semipermeable membrane during ultrafiltration |
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hemodialysis |
3 times a week for 3-5 hrs ESRD and ARF artificial kidney machine to filter waste out of blood via diffusion into a filter requires permanent access via a surgically created fistula into an artery or vein the dialysate causes osmotic pressure that removes waste |
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Goals of Nutritional Care in ESRD |
maintain or obtain optimal nutritional status control edema and e-lyre imbalance by controlling Na, K, and fluid intake Prevent or slow the development of renal osteodystrophy by controlling Ca, PO4 and Vit D intake enable the pt to eat palatable diet that fits their lifestyle |
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MNT: CKD stage 5 HD |
PRO 1.2 (50%HBV) Energy 35 kcal's under 60 yrs 30-35 over 60 yrs Na 2 g/day K 2-3 g/day P 800-1000 mg/day Ca less or equal to 2000mg from diet and meds Fluid output + 1000ml |
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Continuous Cyclic Peritoneal Dialysis (CCPD) |
utilizes he peritoneum to serve as a filter uses a machine to complete dialysis catheter is placed in the abdomen into the peritoneal cavity dialysate used is a high dextrose solution once filtration occurs, the solution is discarded and fresh solution is added less efficient than hemodialysis tx 3 x a week for 10-12 hrs |
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Continuous Ambulatory Peritoneal Dialysis (CAPD) |
does not use a machine exchanges are made using gravity dialysate remains in the peritoneum exchanges occur 4-5 times a day allows for maintenance of a more normal lifestyle increased risk of infection (peritonitis) |
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Alterations in Nutritional Requirements Specific to PD |
more liberal fluid, sodium, and potassium allowances monitor kcal needs, as the dialysate contains 600-800 kcal of which 70% is absorbed |
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MNT: CKD stage 5 PD |
PRO 1.2-1.3 gm/kg (50% HBV) Kcals 35 kcal/kg under 60 30-35 kcal/kg over 60 Na 2 g/day K 3-4 g day P 800-1000 mg/day Ca less than are = 2000mg from diets and meds Fluids monitored: 1500-2000 ml |
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Intradialytic Parenteral Nutriton (IDPN) |
pts receiving hemodialysis can receive IDPN, which is a form of nutrition support for pt who are in negative N balance i.e. impaired GI function with low alb decreased anthros prolonged N/V |
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Nutritional Care for a kidney transplant recipient |
PRO 1.3-1.5 initial 1.0 maintenance Kcals 30-35 initial 25-30 maintenance Ca 1200 mg/day |
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CKD Meds Drug Therapy |
Diuretics |
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CKD Meds AntiHTN |
ACE inhibitors Angiotensin receptor blockers Calcium channel blockers |
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CKD Erythropoietin |
epoetin |
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CKD Meds others |
Feosol Feostat Ferrlicit (IV) Venofer (IV) |
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CKD Supplements |
Vit D, Calcitrol, Paricalcitol (Zemplar), Doxercaliciferol (Hectorol) supplements raise Ca and reduce parathyroid hormone Kayexalate binds excess K Phos-lo, Calphron, Tums, Caltrate, Renagel binds secess P, take with meds Nephrocaps, Nephro-vite, DiatxZn, Nephplex Rx, Dialyvite 3000 |
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Nutritional Concerns in CKD |
anemia malnutrition uremia complications, PRO loss infections renal osteodystrophy Co morbidities Diet education Nutrition support and the CKD pt |
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Nutritional Assesment |
SGA appropriate and validated Diet Hx Weight hx dry and wet Fluid status I/O Medications: help with dosing schedule Lab data |
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LABs CKD |
BUN Na+, Cl- Cr K+ Ca++ PO4 alb, pre-alb, microalbumin urinary sediment and H/H |
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Calculating Renal Diets |
Calculate energy needs Calculate pro needs (50% HBV) use exchanges to determine milk, meat, fruit, vegetable, starch and non-dairy milk substitutes, fat and high kcal choices in the order |
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Renal Diet |
foods high in Sodium canned, pre-prepared and salted foods foods high in potassium potatoes, milk, avocado, dried beans/peas, salt subs can leach potatoes: soak for 2 hrs to remove some of the potassium Food high in phosphorus (reduces ca) milk, cheese, organ meats, bean |
