Renal Diseases

Cards (73)

  • 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)