Renal Diseases

• KIDNEY STONES: NEPHROLITHIASIS

  ●       The most common disorders that affect the kidneys and urinary tract.

  ●       Develop when stones constituents become concentrated in the urine and form crystals that grow.

  ●       Characterized by frequent occurences between the ages 30 to 50.

  ●       Predominance in males (3x more often).

  ●       The risk doubles with a family history of kidney stones.
• Calcium stones - hypercalciuria

  ○       Excess Na and protein can increase Ca loss
• • Uric Acid stones gout
• Nephrolithiasis


  Kidney stones
• Kidney stones is the most common disorder
• Kidney stones


  • Hydration is very important
  • Excess calcium will form stones
  • May cause inflammation
  • Diet prescription is done depending on the size of the stone
• Chronic kidney disease (CKD)

  More prevalent in women
• Kidney stones


  More prevalent in men
• There is no known cause for the pattern of CKD being more prevalent in women and kidney stones being more prevalent in men
• There are articles that state the pattern may be due to the diet as males are more inclined to have higher protein and calcium intake
• There is still no distinct cause of this trend
• Calcium stones

  ○       Calcium phosphate

  ○       Calcium oxalate

  ○       Main difference with uric acid stones is that it is classified into two and this is due to excess Na intake.

  Excess protein and Na increase Ca loss or excretion.
• ●       Uric acid stones

  These are not related to sodium.
• Kidney Stones Factors

  ○       Dehydration

  ○       Obstruction

  ○       Urine Acidity

  Metabolic factors or pre-existing renal disorder
• DIETARY MANAGEMENT : NEPHROLITHIASIS

  ●      Overweight: increased risk for kidney stones

  ●      DASH diet: reduced risk

  ●      Adequate fluid intake

  ●      Avoid excess intake of sodium, animal protein, calcium or oxalate
• Acid-Ash Diet

  Diet with increased sources of acid forming foods (sulfur, phosphorus, chloride) such as meat, fish, eggs and cereals while restricting the

  intake of alkaline-forming foods.

   
• Alkaline-Ash Diet

  Diet with increased intake of alkaline forming foods (Na, K, Mg, Ca) such as fruits, vegetables and milk while limiting the intake of acidforming foods.

   
• Acid-Ash Diet To bring about a reduction in the pH of urine which favors excretion of kidney stones (calcium, magnesium, phosphate and oxalate

  kidney stones)
• Alkaline-Ash Diet To bring about an increase in the pH of urine (uric acid and cystine stones)
• ●       Dietary management depends on the type of  stones

  ●       Acid-ash - acidic food, lower pH

  ●       Alkaline-ash - basic foods, higher pH

  Apple juice may excrete small stones (uric acid)
• URINARY TRACT INFECTION AND PYELONEPHRITIS*       Caused by E. coli, other organisms found in complicated infections associated with DM, urinary stones and immunosuppression.

  Result from obstruction or injury

  Characterized by inflammation of the bladder and/or kidneys*, flank pain and fever for (pyelonephritis)
• DIETARY MANAGEMENT

  ●    Increase fluid intake

  ●    Cranberry juice which contains hippuric acid (prevents bacteria from sticking of bacteria to urinary tract) - not a standard treatment
• ●       Bladder - UTI

  ●       Kidney - pyelonephritis

  ●       UTI more common in females

  Cranberry juice would help but it is not a standard treatment
• NEPHROTIC SYNDROME

  ●      Is not a disease but a distinct cluster of symptoms caused by damage to the glomerular capillaries

  ●      The damage alters the permeability of the glomerular capillaries and allows plasma proteins to escape in the urine (proteinuria)
• NEPHROTIC SYNDROME     Signs and symptoms

  ○      Hypoalbuminemia (2-2.5 g/dL)

  ○      Hypercoagulability

  ○      Abnormal bone metabolism

  ○      Proteinuria

  ○      Anasarca
• Dietary Management: Nephrotic Syndrome

  ●       GOALS:

  ○       Efficient use of protein

  ○       Reduce edema and Improve albumin

  ○       Control lipidemia

  ○       Replace nutrients lost in urine
• Dietary Management: Nephrotic Syndrome Energy: High calorie (35 kcal/kgbw Adults; 60-100 kcal/kgbw Children)

  Protein: 0.8-1.0 g/kgbw/day (HBV)

  Fat: 30% of TER

  Minerals: Sodium: 2,000-3,000 mg/day; Potassium: monitor esp. if with diuretics
• ●       If glomerulus is damaged, kidney doesn’t know what to absorb and excrete

  ●       Anasarca - generalized fluid retention (all over the body)

  ●       When you have nephrotic syndrome, glomerular permeability increases, albumin keeps being excreted in the urine

  ●       When albumin goes down, there may be wasting and fluid may leak out and cause accumulation or edema
• ●       Hypercoagulability - because some of the proteins that leak out in the urine are responsible for coagulation or they are anticoagulants leading to blood clot
• ●       If there is blood clot in the nephron there will be obstruction and renal insufficiency
• ●       Just because protein is leaking doesn’t mean you increase it, have normal protein with HBV

  ●       Should be high in calories to prevent wasting and protein utilization

  ●       Potassium depends on diuretics because the patient flushes out potassium

  If with diuretics, potassium may not be restricted but if with hyperkalemia, potassium must be restricted
• ACUTE GLOMERULONEPHRITIS

  ●      Active inflammation in the glomeruli

  ●      an immunologic response to an infection (usually streptococcal) which damages the glomeruli.

  ●      Most common in children

  ●      Signs and symptoms

  ○      Hematuria

  ○      Hypertension

  ○      Mild loss of renal function

  ■       capillary inflammation damages glomerular barrier to the blood
• CHRONIC GLOMERULONEPHRITIS

  ●      Is caused by slow progressive destruction of the glomeruli of the kidney with progressive lost of kidney function

  ●      Advance stage of a group of kidney disorders, resulting in inflammation and gradual, progressive destruction of the glomeruli

  ●      Causes: DM, HTN, cancer, strep or viral infections, NSAIDs, Lupus

  ●      Signs: proteinuria, blood in the urine, high blood pressure, anemia
• Dietary Management: Glomerulonephritis

  ●       To minimize tissue catabolism

  ●       Prevent/treat uremia

  ●       Prevent/treat edema

  ●       Energy: High calorie (35 kcal/kgbw/day); NPC

  ●       Protein: 0.8-1.0 g/kgbw/day (HBV)

  ●       Sodium and Potassium Restriction

  ●       Fluid Restriction: (amount of output + 500)
• Uremia - formation of toxin in the body
• WHAT HAPPENS WHEN THE KIDNEYS FAIL?

   

  ●       Acute Renal Failure

  ○       Abrupt, short-term loss of kidney function

  ○       Reversible

  ●       Chronic Renal Failure

  ○       Progressive worsening of kidney function

  ○       irreversible , requires dialysis or transplantation

  ●       Uremia

  ○       Constellation of symptoms of kidney failure

  ○       Malaise, weakness, nausesa, and vomiting, muscle cramps, itching, metallic taste (nitrogenous wastes)
• ●       Sometimes there are procedures that affects the kidneys that leads to Acute Renal Failure that may last for hours

  ●       For chronic renal failure, management is to lessen the progression and not to make a healthy kidney as it is irreversible

  ●       Pruritus - medical term for itching

  ○       Itching is due to the toxin buildup

  ○       As when the skin is exposed to chemicals it causes itchiness

  The difference is it is internal. Not touched but is inside and cannot be excreted.
• ACUTE RENAL FAILURE (ARF)

  ●       Caused by toxic injury to the liver, severe hemorrhage, after burns, injuries, shock, transfusions, antibiotics, sepsis

  ●       Sudden reduction in GFR (rapid, reversible)

  Characterized by fluid and electrolyte imbalances and muscle wasting
• Prerenal ARF

  ●  Hyperfused kidneys

  ●  Develops with the impairment/reduce in blood flow [burns, hemorrhage, hypovolemia, cardiac shock)

  ●  Results to decreased urine output and retention of N bases
• Postrenal ARF

  ●  Results from obstruction of urine flow (bladder, cancer, prostatic hyperplasia, blood clots)