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Renal Disease  Kidney functions  The nephrotic syndrome  Acute Renal Disease  Chronic Renal Failure  Kidney Stones

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Text of Renal Disease  Kidney functions  The nephrotic syndrome  Acute Renal Disease  Chronic...

  • Renal Disease

    Kidney functionsThe nephrotic syndromeAcute Renal Disease Chronic Renal Failure Kidney Stones

  • Kidney Functions

    Regulate extracellular fluid volume and osmolarityRegulate electrolyte concentrationsRegulate acid-base balanceExcrete metabolic waste products like urea and creatinine and a number of drugs and toxinsHelp to regulate blood pressureProduce the hormone erythropoietin, which stimulates the production of red blood cells in the bone marrowConvert vitamin D to its active form plays a primary role in calcium regulation and bone formation

  • The Nephrotic Syndrome: Treatment

    Protein and energy Helps minimize losses of muscle tissue High-protein diets not advised can exacerbate urinary protein losses 0.8 1.0 grams of protein per kilogram of body weight/day 35 kcalories/kilogram body weight daily sustains weight and spares protein Weight loss or infectionssignal the need for additional kcalories

  • The Nephrotic Syndrome: TreatmentFat A diet low in saturated fat, cholesterol, and refined sugars helps to control elevated blood lipids May need lipid-lowering medications prescribed per physician

  • The Nephrotic Syndrome: Treatment Sodium Sodium restriction helps to control edema Suggested to limit intake to < 2-3 grams daily If diuretics prescribed for edema potassium wasting may occur Encouraged to select foods rich in potassium

  • The Nephrotic Syndrome: Treatment Vitamins and minerals May require vitamin D and calciumsupplementation prevent bone loss and rickets Multivitamin supplements prevent additional nutrient deficiencies

  • Acute Renal Disease: Consequences

    Kidneys become unable to regulate the levels of electrolytes, acid, and nitrogenous wastes in in blood.Urine may be diminished in quantity or absent.Diagnosis often a complex task.Fluid and electrolyte imbalances

  • Acute Renal DiseaseGoals of nutritional therapy for ARF patients: debilitated:Minimize uremia (accum. of bld nitrogenwaste urea) and maintain the bodys regular chemical compositionPreserve the bodys protein storesMaintain fluid, electrolyte, and acid-base homeostasis

  • Nutritional therapy for ARF patients Protein Due to catobolic condition associated with hypermetabolism and muscle wasting sufficient protein and energy needed to preserve bodys protein content0.6g/kg/day in non-dialyzed, non-hypercatabolic patient. With dialysis protein restricted to 1.2 1.3 Calories 35 kcal/kg of BW/day .

  • Nutritional therapy for ARF patientsFluids.Needed to monitor weight fluctuations, blood pressure, pulse rates, appearance of skin and mucous membranesDaily fluid intake should equal urine output, plus approximately 500ml to replace insensible losses ( the water lost through skin, lungs and perspiration) Individuals with fever, vomiting, or diarrhea requires additional fluidIf on dialysis more liberal fluid intake allowed 1.5-2 liters/day

  • Nutritional therapy for ARF patientsVitamins/Minerals

    Electrolytes must be closely monitored. Potassium and phosphate levels may be elevated. There may also be salt and water imbalances. With oliguria (abnl production of urine) sodium intakes limited to 2-3 grams dailyIf on dialysis-generally can consume electrolytes more freelyOliguric patients who experience diuresis may need electrolyte replacement to compensate for urinary lossesSome patients need enteral or parenteral nutrition support to obtain adequate energy (high Kcal Low ptn and electrolytes)

  • Chronic Renal Failure: ConsequencesGenerally progresses over many years without causing symptomsTypically diagnosed late in the course of illness, after most kidney function has been lostMost common causes : Diabetes mellitus (43%) Hypertension (26%) Altered electrolytes and hormonesUremic syndrome

  • Chronic Renal Failure Goals of nutritional therapy.Prevent symptoms of uremia while restoring biochemical balance. Retard progression of the disease. Provide adequate calories to maintain or achieve ideal body weight.

  • Nutritional therapy for chronic renal failure Protein Protein should be restricted to 0.6g/kg/day, with sufficient essential amino acids. Once dialysis begun protein restrictions relaxed Dialysis removes nitrogenous wastes Some amino acids lost during the procedure.Calories Calorie intake should be about 35 kcal/kg to maintain body weight. Foods and beverages of high nutrient density Malnourished patients may require oral formulas or tube feedings to maintain weight

  • Nutritional therapy for chronic renal failure

    Fat Restrict saturated fat and cholesterol levels, some renal patients at risk for coronary heart.Renal diets include high-fat foods to increase calories encourage patients to select foods providing mostly monounsaturated fats.

  • Nutritional therapy for chronic renal failureFluids and Sodium Fluid intake should be based on the patients ability to eliminate fluidFluid intake should match the daily urine output,if urine output decreases Fluids should be restricted Excrete less urine as CRF progresses cant handle normal sodium and fluid intakeMonitor total urine output, changes in body weight and blood pressure and serum sodium levels2-3 gm/d.adeq., but 1gm/d if the renal failure is severe. Once on dialysis sodium and fluid intakes controlled so that water weight gain is 2 pounds between dialysis treatments

  • Nutritional therapy for chronic renal failurePotassium 2 to 3 gms/day should be initiated. Calcium and Phosphate supplement calcium and restrict phosphate to 8-12 mg/kg/day. Vitamins and Mineral- Supplementing folic acid, B6, B-complex, Vitamin D, Vitamin C necessary. Vitamin A and E not recommended because it may accumulate with renal failure.

  • Kidney Transplants Immunosuppressive Drug Therapy Side effects of nausea, vomiting, diarrhea, glucose intolerance, altered blood lipids, fluid retention, hypertension and infection Increases risk of food borne infection food safety guidelines discussed with patients and caregivers Dietary interventions

  • Kidney TransplantsEnergy: 30-35kcal/kg/d. adjust to maintain reasonable weight.Protein: 1.3-1.5 g/kg/d ,reduced to 1g/kg/d after 6-8 weeksCarbohydrate: consistent CHO intake/d. increase fiber.Fat: Limited saturated fat and cholesterol to help control serum lipids.Sodium: Restricted (to 2-4g/d ) if fluid retention and hypertension are present.Potassium: adjust according to serum potassium levels.Calcium: 1000 to 1500 mg to minimize bone loss associated with drug therapy.Phosphorus: 1200-1500 mg: supplement needed if serum phosphorus is low.Fluid: No restriction

  • Kidney Stones

    Kidney stone crystalline mass that forms within the urinary tract . Stone passage can cause severe pain or block the urinary tract.Formation of kidney stones- 75% of kidney stones made up primarily of calcium oxalateFactors that predispose to stone formation: Dehydration or low urine volume Renal disease Urine acidity Metabolic factors Calcium oxalate stones Uric acid stones Cystine stones Struvite stones (could be initiated by bacteria forming from ph)

  • Kidney Stones: ConsequencesConsequences of kidney stonesRenal colicUrinary tract complications

  • Kidney Stones: Prevention and treatment of kidney stones Diet containing 800 1000 mg of calcium per day is recommended because calcium combines with oxalate in the intestines, reducing its absorption and helping to control hyperoxaluria Moderate protein and sodium restriction advisedHigh fluid intakes recommended

  • hemodialysis

  • peritoneal dialysis

  • Thank you!

    *It has been a pleasure working with you. It is exciting to focus this training program on you who hold the key to the success of Child Nutrition Programs. It is in your hands.

    Thank you for your time and I hope you have a great day.