In one survey, fewer than 6% of individuals with reduced kidney function were aware of their condition.
Specific substances are reabsorbed and secreted by the four parts of the tubules.
What is the glomerular filtration rate? (The rate at which blood is filtered through the glomerulus)
The concentrated urine usually amounts to 1% or less of the filtered fluid.
At birth, each person has far more nephrons than are actually needed.
Renin initiates the renin-angiotensin-aldosterone system.Parathyroid hormone activates vitamin D.
Agents that are toxic to the kidneys are said to be nephrotoxic.
Can a person born with only one kidney lead a healthy life without treatment? (Yes. Because of the abundance of nephrons at birth, people born with one kidney often are unaware of their condition and lead full lives.)
Mrs. Hendricks is a 65-year-old female who has poor glycemic control with her Type 2 diabetes of 32 years, hypertension, and smokes 1 pack of cigarettes per day. Her most recent glomerular filtration rate is 22 mL/min.
Risk factors for CKD:Older ageRacePoor glycemic control/diabetesHypertensionSmokerDecreased glomerular filtration rate
When a patient is being treated with dialysis, working closely with an RD for customized nutrition therapy is especially important.
Glomerulonephritis is one of the three most common causes of end-stage renal disease.
With nephrosis, both filtration and reabsorption functions of the nephron are disrupted.
The primary goals of nutrition therapy are to control major symptoms and replace nutrients lost in the urine.
Acute renal failure presents a life-threatening situation.
The major sign of acute kidney injury is an increase in serum creatinine and oliguria.
Enteral or parenteral nutrition may become necessary.Medical nutrition therapy may vary greatly, depending on the patient.
Some risk factors are modifiable, including control of blood pressure and smoking.
Anemia results because the kidneys cannot perform their normal function of stimulating RBC production through erythropoietin.
Nervous system involvement may cause muscular twitching, burning sensations in the extremities, or convulsions.
Some recommendations vary depending on whether the patient is receiving dialysis.
Mrs. Hendricks is in stage 4: Severely decreased GFR 15 to 29 mL/min. Mrs. Hendrick’s is at 22 mL/min.
GoalsReduce protein breakdownAvoid dehydration or excess hydrationCorrect acidosisCorrect electrolyte imbalancesControl fluid and electrolyte lossesMaintain optimal nutritional statusMaintain appetite and moraleControl complications of hypertension, bone pain, nervous system involvementSlow rate of renal failurePrinciplesProvide enough protein therapy to maintain tissue integrity while avoiding excessProvide amino acid supplements for protein supplementation as necessaryReserve protein for tissue synthesis by ensuring adequate carbohydrates and fatsMaintain adequate urine volume with water(Possibly) restrict sodium, phosphate, calcium as necessarySupplement diet with multivitamin as necessary
Dialysis is the chief treatment for end-stage renal disease.
Medical nutrition therapy involves registered dietitians specializing in renal care.
The diet is slightly more liberal for the patient receiving peritoneal dialysis.
Continuous ambulatory peritoneal dialysis.
Medical nutrition therapy for patients awaiting kidney transplantation is highly individualized.
Nutrition support for kidney transplantation patients is highly individualized.
Patients with any level of kidney dysfunction should be evaluated for bone disease.
Review Box 21-2 for the risk factors for kidney stone development.
It is a common error to limit calcium intake in persons who form calcium oxalate stones.
These are often called “infection stones.”
Uric acid stones may occur with the rapid tissue breakdown during wasting disease or with diarrheal illness, diabetes, obesity and metabolic syndrome.
A large fluid intake helps to dilute urine and prevent the accumulation of materials that form stones.
All of these approaches include the goal of reducing the intake of the stone constituent.