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NHHC chapter 22 ppt
- 1. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Nutrition and Renal Diseases Chapter 22
- 2. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Introduction • Kidneys – Filter the blood and remove excess fluid and wastes for elimination in urine – Nephron: working unit of the kidney • Glomerulus: filters water and solutes from the blood • Bowman’s capsule: surrounds the glomerulus; collects the filtrate that is passed to the tubules
- 3. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Introduction (cont’d.) • Kidneys – Regulate the extracellular fluid volume • Control osmolarity, electrolyte concentrations, and acid-base balance – Excrete metabolic waste products • Urea and creatinine; various drugs and toxins – Other roles • Secretes renin, produces erythropoietin, and converts vitamin D to active form
- 4. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014
- 5. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 The Nephrotic Syndrome • Disorders causing severe glomerular damage: significant proteinuria – Damage to glomeruli • Increases permeability to plasma proteins • Causes – Glomerular disorders, diabetic nephropathy, immunological and hereditary diseases, infections (kidneys or other), etc.
- 6. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 The Nephrotic Syndrome (cont’d.) • Consequences of the nephrotic syndrome – Attempting to compensate: liver increases synthesis of various plasma proteins • Some or the proteins produced in excess – Edema • Hypoalbuminemia: contributes to a fluid shift from blood plasma to the interstitial spaces • Impaired sodium excretion: sodium and water retention
- 7. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 The Nephrotic Syndrome (cont’d.) • Consequences of the nephrotic syndrome – Blood lipid abnormalities • Elevated levels of LDL, VLDL, and lipoprotein(a) – Blood clotting abnormalities • Increased risk of deep vein thrombosis – Other effects • Susceptibility to infection; increased risk of rickets (children); PEM and muscle wasting
- 8. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014
- 9. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 The Nephrotic Syndrome (cont’d.) • Treatment of the nephrotic syndrome – Requires diagnosis and management of the underlying disorder – Medications for complications • Diuretics, ACE inhibitors, lipid-lowering drugs, anti-inflammatory drugs, and immunosuppressants – Nutrition therapy • Helps to prevent PEM, correct lipid abnormalities, and alleviate edema
- 10. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 The Nephrotic Syndrome (cont’d.) • Nutrition therapy – Protein and energy • Adequate to meet needs: helps minimize muscle tissue losses • Why are high-protein diets not advised? – Lipids • Dietary measures: usually inadequate for controlling blood lipids • Lipid-lowering medications: usually prescribed
- 11. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 The Nephrotic Syndrome (cont’d.) • Nutrition therapy – Sodium and potassium • Low-sodium: helps control edema (Table 22-1) • Foods rich in potassium encouraged – Vitamins and minerals • Supplements help patients avoid nutrient deficiencies: particularly vitamin B6, vitamin B12, folate, iron, copper, and zinc
- 12. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 The Nephrotic Syndrome (cont’d.) • Nutrition therapy – Vitamins and minerals • Calcium and vitamin D supplements also advised
- 13. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Acute Kidney Injury • Kidney function deteriorates rapidly, over hours or days – Reduced urine output and build-up of nitrogenous wastes in blood • Causes of acute kidney injury – Consequence of severe illness, injury, or surgery
- 14. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Acute Kidney Injury (cont’d.) • Causes of acute kidney injury – Prerenal factors: cause a sudden reduction in blood flow to the kidneys • Often involve a severe stressor such as heart failure, shock, or blood loss – Intrarenal causes: factors that damage kidney tissue • Infections, toxicants, drugs, or direct trauma
- 15. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Acute Kidney Injury (cont’d.) • Causes of acute kidney injury – Postrenal factors: prevent excretion of urine due to urinary tract obstructions
- 16. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014
- 17. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Acute Kidney Injury (cont’d.) • Consequences of acute kidney injury – Altered composition of blood and urine • Kidneys unable to regulate levels of electrolytes, acid, and nitrogenous wastes in the blood • Conditions of oliguria or anuria – Fluid and electrolyte imbalances • Sodium retention: edema • Hyperkalemia: alters heart rhythm; heart failure • Hyperphosphatemia: leads to bone calcium losses
- 18. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Acute Kidney Injury (cont’d.) • Consequences of acute kidney injury – Uremia • Nitrogen-containing compounds and various other waste products: may accumulate in the blood – Uremic syndrome: cluster of disorders • Impairments in multiple body systems
- 19. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Acute Kidney Injury (cont’d.) • Treatment of acute kidney injury – Combination of drug therapy, dialysis, and nutrition therapy • Restore fluid and electrolyte balances • Minimize blood concentrations of toxic waste products
- 20. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Acute Kidney Injury (cont’d.) • Treatment of acute kidney injury – Drug treatment in acute kidney injury • Why may it be necessary to lower doses of some usual medications, while others may need to be increased? • Nephrotoxic drugs: must be avoided until kidney function improves
- 21. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Acute Kidney Injury (cont’d.) • Treatment of acute kidney injury – Drugs for acute kidney injury: depend on cause of illness and complications • Immunosuppressants: inflammatory conditions • Diuretics: edema • Hyperalkalemia: potassium-exchange resins; may require insulin • Other medications
- 22. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Acute Kidney Injury (cont’d.) • Treatment of acute kidney injury – Energy and protein • Sufficient energy and protein: preserve muscle mass • Protein recommendations : influenced by kidney function, degree of catabolism, and use of dialysis
- 23. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Acute Kidney Injury (cont’d.) • Treatment of acute kidney injury – Fluids • Estimate needs: measure urine output and add 500 milliliters for water lost from skin, lungs, and perspiration – Electrolytes • Serum electrolyte levels monitored closely: determine appropriate electrolyte intakes
- 24. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Acute Kidney Injury (cont’d.) • Treatment of acute kidney injury – Enteral and parenteral nutrition • In cases requiring additional nutritional support, why is enteral support preferred over parenteral nutrition? – Case Study – Woman with Acute Kidney Injury
- 25. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease • Gradual, irreversible deterioration • Kidneys: large functional reserve – Chronic disease typically progresses over many years without causing symptoms • Most common causes – Diabetes mellitus and hypertension – What are other causes of chronic kidney disease?
- 26. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Consequences of chronic kidney disease – Early stages • Nephrons compensate by enlarging to handle the extra workload – End-stage renal disease • Advanced stage of chronic kidney disease: dialysis or a kidney transplant is needed to sustain life – Many symptoms: nonspecific • Delays diagnosis of the condition
- 27. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014
- 28. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014
- 29. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Assessing kidney function – Glomerular filtration rate (GFR) • Rate at which the kidneys form filtrate • Estimated using predictive equations: based on serum creatinine levels, age, gender, race, and body size • Categorized into stages (Table 22-4) – What other tests can assess kidney function?
- 30. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Altered electrolytes and hormones – As GFR falls: • Remaining neurons increase activity to maintain electrolyte excretion – Electrolyte disturbances • May not develop until third or fourth stage of chronic kidney disease
- 31. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Altered electrolytes and hormones – Some hormonal adaptations to regulate electrolyte levels create new complications • Increased aldosterone ► hypertension • Parathyroid hormone ► renal osteodystrophy • Clinical effects of uremic syndrome – Hormonal imbalances • Lead to anemia, bone disease, etc.
- 32. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Clinical effects of uremic syndrome – Altered heart function/increased heart disease risk – Neuromuscular disturbances • Malaise, irritability, sensory deficits, seizures, etc. – Other effects • Defects in platelet function and clotting factors; increased skin pigmentation and severe pruritus; suppressed immune responses
- 33. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Protein-energy malnutrition – Anorexia: contributes to the poor food intake • Due to hormonal disturbances, nausea and vomiting, restrictive diets, uremia, and medications – Nutrient losses • Consequence of vomiting, diarrhea, gastrointestinal bleeding, and dialysis – Catabolic state
- 34. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Treatment of chronic kidney disease – Treatment goals • Slow disease progression • Prevent or alleviate symptoms – Drug therapy for chronic kidney disease • Antihypertensive drugs • Erythropoietin (epoetin): anemia • Others: phosphate binders, sodium bicarbonate, and active vitamin D
- 35. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Treatment of chronic kidney disease – Dialysis: removes excess fluid and wastes from the blood • Hemodialysis: blood is circulated through a dialyzer – Nutrition therapy for chronic kidney disease (Table 22-5)
- 36. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Nutrition therapy for chronic kidney disease – Energy: adequate intake to maintain a healthy weight and prevent wasting – “How To” Increase kCalories and Protein in Meals (Chapter 23) – Protein: enough protein to meet needs and prevent wasting • Between 0.6 and 0.8 g/kg of body weight per day in later stages
- 37. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Nutrition therapy for chronic kidney disease – Lipids: restrict intakes of saturated fat, trans fat, and cholesterol • Why are persons with chronic kidney disease often encouraged to consume high-fat foods? – Sodium and fluids • Mild sodium restriction may be beneficial • Fluids: not restricted until urine output decreases • What water intake restrictions apply during dialysis?
- 38. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Nutrition therapy for chronic kidney disease – Potassium • Early stages: normal potassium intake levels • Hyperkalemia conditions: potassium restrictions • Potassium-diuretics: potassium supplementation • Dialysis patients: control potassium intake (Table 22-6)
- 39. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Nutrition therapy for chronic kidney disease – Phosphorus, calcium, and vitamin D • Serum phosphorus and calcium levels: monitored in kidney disease patients • Elevated phosphorus levels: restrict intake • What accounts for the risk of hypercalcemia? • Vitamin D supplements
- 40. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014
- 41. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Nutrition therapy for chronic kidney disease – Vitamins and minerals • Multivitamin supplements: typically recommended for all patients with chronic kidney disease • Limit vitamin C: 100 milligrams per day • Vitamin A supplements: not recommended • Hemodialysis patients: intravenous iron along with erythropoietin therapy
- 42. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Nutrition therapy for chronic kidney disease – Enteral and parenteral nutrition • Formulas: more kcalorically dense and lower protein and electrolyte concentrations than standard formulas • What is intradialytic parenteral nutrition?
- 43. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Nutrition therapy for chronic kidney disease – Diet compliance: difficult aspect of treatment (Table 22-8) – Case Study – Man with Chronic Kidney Disease
- 44. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Kidney transplants – Benefits • Restores kidney function, allows a more liberal diet, and frees the patient from routine dialysis – What are barriers to kidney transplants? – Immunosuppressive drug therapy • Prevent tissue rejection following transplant surgery • Be aware of diet-drug interactions (listed in text)
- 45. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Chronic Kidney Disease (cont’d.) • Nutrition therapy after kidney transplant – Most nutrients • Consume at levels recommended for the general population – Primary reason for dietary adjustments • Side effects of drugs
- 46. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Kidney Stones • Crystalline mass – Forms within the urinary tract • Formation of kidney stones – Stone constituents become concentrated in urine • Allowing crystals to form and grow – Most common constituent • Calcium oxalate
- 47. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Kidney Stones (cont’d.) • Factors predisposing an individual to stone formation – Dehydration or low urine volume – Obstruction – Urine acidity – Metabolic factors – Renal disease
- 48. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Kidney Stones (cont’d.) • Types of kidney stones – Calcium oxalate stones • Hypercalciuria: common abnormality in people with calcium oxalate stones – Uric acid stones • Urine: abnormally acidic; contains excessive uric acid, or both • Frequently associated with gout
- 49. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Kidney Stones (cont’d.) • Types of kidney stones – Cystine and struvite stones • Cystine stones: people with inherited disorder cystinuria • Struvite stones: composed primarily of magnesium ammonium phosphate; form in alkaline urine
- 50. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Kidney Stones (cont’d.) • Consequences of kidney stones – Renal colic • Severe, stabbing pain when stone passes through the ureter • Hematuria: blood in urine – Urinary tract complications • Urination urgency, frequent urination, or inability to urinate • Urinary tract obstruction, and possibly infection
- 51. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Kidney Stones (cont’d.) • Prevention and treatment of kidney stones – Drink 12 to 16 cups of fluids daily • Maintain urine volumes of at least 2½ liters per day – Calcium oxalate stones • Reduce urinary calcium and oxalate levels • Adjust calcium, oxalate, protein, and sodium intakes • Medications: diuretics; drugs to inhibit crystal formation; and drugs to reduce uric acid production
- 52. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Kidney Stones (cont’d.) • Prevention and treatment of kidney stones – Uric acid stones • Diets restricted in purines: may help to control urinary uric acid levels • Drug treatments: allopurinol to reduce uric acid levels and potassium citrate to reduce urine acidity
- 53. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Kidney Stones (cont’d.) • Prevention and treatment of kidney stones – Cystine and struvite stones • High fluid intakes • Medications may be needed • What is a central strategy in preventing struvite stones?
- 54. Nutrition for Health and Health Care, 5th Edition DeBruyne ■Pinna © Cengage Learning 2014 Kidney Stones (cont’d.) • Medical treatment for kidney stones – Medications • Relax ureter • Increase urine flow – Extracorporeal shock wave lithotripsy • High-amplitude sound waves to degrade the stone – Surgical methods • Higher success rate • More invasive
Editor's Notes
- Figure 22-1 The Kidneys and Nephron Function
- Figure 22-2 Consequences of Urinary Protein Losses in the Nephrotic Syndrome
- Table 22-2 Causes of Acute Kidney Injury
- Table 22-3 Clinical Effects of Chronic Kidney Disease
- Table 22-3 Clinical Effects of Chronic Kidney Disease
- Table 22-7 Foods High in Phosphorusa aFor a complete list, visit the USDA’s Nutrient Database at www.nal.usda.gov/fnic/foodcomp/search. Click on “Nutrient lists,” and then find the list of foods sorted in descending order by phosphorus content (click on the letter “W” to the right of the word “Phosphorus”).