Note

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Note
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Lecture 8c 7 March 2011   Renal continued
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Renal Disease   Acute Renal Failure Sudden
loss of kidneys ability to function -leads
to a loss of ?   Occurs due to
heart failure or shock or urinary tract
obstructions
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Renal Disease   Acute Renal Failure
Consequences Decreased glomerular filtration
rate which upsets Fluid and electrolyte and
acid base balances   Increase in BUN,
blood creatinine and blood uric acid
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Renal Disease  Acute Renal Failure Blood
electrolyte levels rise when protein is
catabolised for energy gives Increased blood
levels of potassium- why?   Increased
potassium levels in blood affect heart rate
and can lead to heart failure-why?
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Renal Disease  Acute Renal Failure Treatment
Dialysis  
Nutrition   Energy -too little energy leads
to protein breakdown -blood urea and
potassium up   -35 kcal/kg body weight/day to
start then adjustments
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Renal Disease  Acute Renal Failure Treatment 
Nutrition Protein -better to
give extra protein to address wound healing,
infections, muscle wasting and negative
nitrogen balance and dialyse the overload   -0.6
to 0.8 g of protein /kg body weight per day
no dialysis   -up to 2 g of protein /kg body
weight per day if kidney function improves or
if on dialysis
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Renal Disease  Acute Renal Failure Treatment 
Nutrition Fluids -over- or
under-hydrated must be addressed - urine
output plus 500 ml for water lost though skin,
lungs, and perspiration (vomiting diarrhea,
fever add more than 500 ml)
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Renal Disease  Acute Renal Failure Treatment 
Nutrition Sodium -restrict sodium
to 1.1-3.3 grams per day in oliguric phase
(decreased urine volume) -sodium losses in
urine should match sodium intake unless edema
-perhaps more in diuretic phase
(increased urine volume and electrolyte
loss) and more
liberal if on dialysis  
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Renal Disease  Acute Renal Failure Treatment 
Nutrition Potassium 2-3 grams per
day-generally speaking Phosphorous- restrict if
hyperphosphatemia
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Renal Disease  Acute Renal Failure Treatment 
Nutrition Enteral - severe stress
requires enteral feeding -protein and
electrolyte restricted, more
kcal   TPN-mixture of essential and
non- essential amino acids at lower and dextrose
at higher concentrations than regular TPN
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Chronic renal failure Causes Include blood
lipids, diabetes, hypertension
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Chronic renal failure Treatment Energy -too
little energy leads to protein breakdown -bl
ood urea and potassium up   -30-35 kcal/kg body
weight/day -less on peritoneal dialysis-
glucose load -table 28-5
Rolfes et al
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Chronic renal failure Treatment Protein -as
loss of renal function progresses -50(at
least)/50 split of animal/plant
protein-explanation-why? -as progresses
even further supplement with essential amino
acids and precursors of essential amino
acids   -once dialysis begins- can relax
protein restrictions
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Chronic renal failure Treatment Lipid and
carbohydrate -restrict total and saturated fat
and cholesterol -complex
carbohydrates may minimise elevated glucose
and triglycerides -peritoneal dialysis-
restrict dietary simple carbohydrates-why?  
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Chronic renal failure Treatment Sodium and
Fluids -restrict as loss of renal function
progresses -prevents edema, hypertension and
heart failure   -needs governed by
persons weight, blood pressure,
urinary output and electrolyte levels
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Chronic renal failure Treatment Potassium
-individualised according to serum values
for pre-dialysis, 2-3 grammes on
hemodialysis, and 3-4 grammes on
peritoneal dialysis -table 28-5 Rolfes et
al  
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Chronic renal failure Treatment Phosphorous
-restrict as renal failure
progresses -increased blood phosphate happens
here and causes decreased active vitamin D
and hence decreased calcium intakes (intake
absorption)   -milk products, peanut
butter, sardines and legumes are high in
phosphorous
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Chronic renal failure Treatment   Vitamins-
-increase B6 and folate these are
reduced by restrictive diets, dialysis,
and drug therapy   Iron supplements
-required for hemoglobin synthesis
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Chronic renal failure Treatment   Complex
carbohydrates and restrict fat, protein and in
some cases simple carbohydrates   -choose
complex carbohydrates carefully because many
contain potassium (eg apricots, bananas)
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Functional Foods/Nutraceuticals to prevent or
treat nephrotic syndrome acute and chronic
renal failure fish/fish oil protein-fish
- a problem for treatment reduces
-inflammation -blood
pressure -lipids