Chronic and acute renal disorders are discussed in brief

2. CHRONIC RENAL DISEASE
 Progressive and irreversible loss of renal
function over time.
 It is based on the gradual decline in GFR
and Creatinine clearance
 Most frequently it leads to end stage
renal disease.

5. SYMPTOMS
 Nausea
 Vomiting
 Loss of appetite
 Fatigue and weakness
 Sleep problems
 Changes in how much you urinate
 Decreased mental sharpness
 Muscle twitches and cramps
 Swelling of feet and ankles
 Chest pain, if fluid builds up around the lining of the heart
 Shortness of breath, if fluid builds up in the lungs
 High blood pressure (hypertension) that's difficult to control

6. DIAGNOSIS
 Renal ultrasound-it can show
renal size and position, dilatation
of the collecting system (due to
obstruction), distinguish tumors
and cysts.
 Quick, inexpensive and harmless

7. CAUSES
 Type 1 or type 2 diabetes.
 High blood pressure.
 Glomerulonephritis, an inflammation of the kidney's filtering
units (glomeruli).
 Interstitial nephritis, an inflammation of the kidney's tubules
and surrounding structures.
 Polycystic kidney disease.
 Prolonged obstruction of the urinary tract, from conditions such
as enlarged prostate, kidney stones and some cancers.
 Vesicoureteral reflux, a condition that causes urine to back up
into your kidneys.
 Recurrent kidney infection, also called pyelonephritis.

8. RISK FACTORS
 Diabetes
 High blood pressure
 Heart and blood vessel (cardiovascular)
disease
 Smoking
 Obesity
 Being African-American, Native
American or Asian-American
 Family history of kidney disease
 Abnormal kidney structure
 Older age

9. COMPLICATIONS
 Fluid retention
 Hyperkalemia
 CVD
 Weak bones and an increased risk of bone
fractures.
 Anemia
 Decreased sex drive, erectile dysfunction or
reduced fertility.
 Decreased immune response
 Pericarditis
 CNS gets damaged
 Pregnancy complication

10. TREATMENT
 For early stage treatment includes, treating
complications like hypertension, diabetes,
hypercholesterolemia, anemia, swelling and
lower protein diet.
 For end stage renal failure the treatment
includes:
 Dialysis
 Hemodialysis
 Peritoneal dialysis
 Haemofiltration
 Transplantation with immunosuppressive
agents

11. MANAGEMENT
 Identify the underlying cause for
renal disease
 Attempt to prevent further renal
damage
 Look for reversible factors(UTI,
U.obs, medications) which are
making renal function worse
 Attempt to limit the adverse effects of
the loss of renal function
 Replacement therapy- Dialysis,
transplantation.

12. DIETARY
MANAGEMENT
 Energy: 35-50 kcal/kg
 Protein: 15-20 g/day
 Fluid and electrolytes: daily urine
output+500ml
 Sodium: 40-60 mMol/day
 Potassium: 4g/day
 Phosphorus: 800-1000mg/day
 Calcium: maintain the RDA

13. PREVENTION
 Manage diabetes, high blood
pressure, and heart disease.
 Explore stress-reducing
activities.
 Stop smoking.
 Get enough sleep.
 Limit alcohol intake.
 Aim for a healthy weight.
 Make physical activity part of a
day routine.
 Make healthy food choices.

14. KIDNEY STONES
 Kidney stones are small ,hard deposits
of mineral and acid salts on the surfaces
of the kidneys
 Alternate names: Renal lithiasis, Renal
calculi and Nephrolithiasis
 Stones are classified by their location in
the urinary system and their
composition of crystals.

16. CAUSES
 Climate
 Occupation
 Infection of urinary tract
 Dietary habits
 Heredity
 Vitamin A and B deficiency
 Hyperthyroidism
 Being obese
 Digestive disease and surgery
 Gout

17. TYPES OF STONES
 Calcium- maximum oxalates
but can also be phosphate and
maleate
 Struvite
 Uric acid
 cysteine

18. SYMPTOMS
 Pain that radiates to the lower abdomen and groin
 Pain that comes in waves and flatulence in intensity
 Pain in urination
 Pink, red or brown urine
 Cloudy or foul smelling urine
 Nausea & vomiting
 Persistent need to urinate
 Urinating more often than usual
 Fever and chills if an infection is present
 Urinating small amounts
 Pain caused by a kidney stone may change for instance,
shifting to a different location or increasing in intensity
as the stone moves through your urinary tract.

19. DIAGNOSIS
 Urine test for infections and
pieces of stones
 Blood test to check kidney’s
function
 Imaging test: CT scan, X-ray,
ultra sound scan,
 IVU/IVP

20. RISK FACTORS
 Immobility
 Sedentary life style
 Dehydration
 Metabolic disturbances
 History of renal calculi
 High mineral content in
drinking water
 Dietary intake
 Neurogenic bladder

21. Treatment
 Extracorporeal shock wave lithotripsy (ESWL)
 Ureteroscopy
 Percutaneous nephrolithotomy (PCNL)
 Open surgery
 These above process are carried out when the
medication doesn't work.

22. DIETARY
MODIFICATION
Calcium Phosphates Oxalates Purines
 Leafy vegetables
 Milk & milk
products
 Sesame seed
 Ragi
 Whole cereals
 Legumes
 Nuts & oil seeds
 Meat fish milk & egg
 Leafy vegetables
 Beetroots
 Tea
 Cocoa
 Raw plantain
 Meat
 Fish
 Animal tissues
 Organs
 Principle of diet:
 Adequate calorie
 Adequate protein
 High fluid
 Objective:
 To give dietary counselling to plan
right type of diet
 To improve the pre-operative
nutrition.
 To maintain correct nutrition
profile after operation.

23. Planning acid ash diet
 A liberal fluid intake is important. Salt may be used in moderation. The fruits and vegetables so
selected should not contribute more than 25ml of base daily.
Planning alkaline-ash diet
 If stones of uric acid or cysteine type occur, the diet should give alkaline ash such a regimen stresses
the use of alkali producing foods such as fruits, vegetables and milk while acid producing foods like
meat, egg and cereal are restricted. The diet must contain all essential of good nutrition.
Planning low oxalate diets
 An acid or alkali reaction of the diet is of little value for oxalate urolithiasis. However foods that are
significant source of oxalates should be omitted which include beans, beet greens chocolate, cocoa,
dried figs, potatoes, spinach, tea and tomatoes.

24. Acid producing Alkaline producing Neutral producing
 Bread
 Whole wheat
 Cereals
 Corn
 Eggs
 Lentils
 Noodles
 Meat fish poultry
 Rice
 Walnuts
 Milk
 Fruits
 Vegetables
 Almonds
 Apricots
 Beans
 Beet roots
 Dates
 Figs
 Raisins
 Food prepared with baking powder or baking soda
 Butter
 Coffee
 Fats
 Sugar
 Tapioca
 Tea

25. Diet Type of stone Foods to be included Foods to be excluded
Acid ash diet Ca & Mg phosphate and carbonate Cereals
Non veg foods
Protein rich foods
 Bakery products
 Milks
 Fruits & vegetables
Alkaline ash diet Uric acid & cysteine stone Bakery products
Milk
Fruits & vegetables
 Cereals
 Non veg foods
 Protein rich foods
Low oxalate diet Calcium oxalate stones Other than the foods excluded  Beets
 Greens spinach
 Teas
 Tomatoes
 Potatoes
 Chocolates
 Cocoa
 Calcium rich foods also be restricted