ST1 PPT

• Nephron

  Functional unit of the kidney

  
• Glomerulus

  • Ball-shaped tuft of capillaries
  • Blood filtration
• Proximal Tubule


  • Various substances are actively or passively reabsorbed, secreted, or metabolized
• Distal Tubule & Loop of Henle


  • Secretion of potassium and hydrogen ions, and the regulation of water
• Medulla


  • Urine concentration
• Functions of the kidneys


  • Maintaining acid-base balance
  • Maintaining water balance
  • Electrolyte balance
  • Toxin removal
  • Blood pressure control
  • Making erythropoietin
  • Vitamin D metabolism
• Filtering Process


  1. Blood enters the kidneys through the artery from the heart

  2. Blood is cleaned by passing through millions of nephrons

  3. Waste material is filtered out by nephrons and passes through the ureter and is stored in the bladder

  4. After the bladder becomes full, urine passes out of the body through the urethra

  5. Newly cleaned blood returns to the bloodstream via veins
• Diseases of the kidney

  • Infection
  • Obstruction
  • Inflammation
  • Hypertension
  • Diabetes
  • Drugs, herbal medicine, solvents and insecticides
  • Abnormalities in the urinary tract
• Albuminuria


  Leaking of small amounts of albumin, first sign of renal insufficiency
• Albumin-to-creatinine ratio (ACR)


  First method of preference to detect elevated protein
• Glomerular Filtration Rate (GFR)


  Measures kidney function, reflected in clearance tests that measure the rate at which substances are cleared from the plasma by the glomeruli
• GFR

  Used to evaluate kidney health, estimate the severity of disease and monitor disease progression
• Serum Creatinine


  As kidney function decreases, levels start to increase, cannot be used to measure GFR

  
• Blood Urea Nitrogen (BUN)


  From protein breakdown, decreased kidney function: increased BUN level

  
• Ultrasound


  • Uses sound waves to get a picture of the kidney, used to look for abnormalities in size or position of the kidneys or for obstructions such as stones or tumors

  
• CT Scan


  • Imaging technique uses X-rays to picture the kidneys, may also be used to look for structural abnormalities and the presence of obstructions, may require the use of intravenous contrast dye which can be of concern for those with kidney disease
• Urinalysis


  • Can help to detect a variety of kidney and urinary tract disorders, including chronic kidney disease, diabetes, bladder infections and kidney stones

  
• Urine Protein


  To detect presence of excess amount of protein in the urine
• Types of kidney stones


  • Calcium stones
  • Uric acid stones
• Dietary management for 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, to bring about a reduction in the pH of urine which favors excretion of kidney stones
• 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 acid-forming foods, to bring about an increase in the pH of urine
• 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 for urinary tract infection and pyelonephritis

  • Increase fluid intake
  • Cranberry juice which contains hippuric acid (prevents bacteria from sticking of bacteria to urinary tract) - not a standard treatment
• Nephrotic syndrome


  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)
• Goals of dietary management for nephrotic syndrome


  • Efficient use of protein
  • Reduce edema and improve albumin
  • Control lipidemia
  • Replace nutrients lost in urine
• Dietary recommendations for nephrotic syndrome

  • Energy: High calorie (35 kcal/kgbw Adults; 60-100kcal/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
• Acute Glomerulonephritis


  Active inflammation in the glomeruli, an immunologic response to an infection
• Proteinuria


  Allows plasma proteins to escape in the urine
• Energy


  • High calorie (35 kcal/kgbw Adults; 60-100kcal/kgbw Children)
• Protein


  • 0.8-1.0 g/kgbw/day (HBV)
• Fat


  • 30% of TER
• Sodium


  • 2,000-3,000 mg/day
• Potassium


  • Monitor esp. if with diuretics
• Acute Glomerulonephritis


  Active inflammation in the glomeruli, an immunologic response to an infection (usually streptococcal) which damages the glomeruli, most common in children
• Chronic Glomerulonephritis


  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

  
• To minimize tissue catabolism

  Goal of dietary management for Glomerulonephritis
• Prevent/treat uremia


  Goal of dietary management for Glomerulonephritis
• Prevent/treat edema


  Goal of dietary management for Glomerulonephritis
• Fluid Restriction


  • Amount of output + 500