Note

Lecture 8c 7 March 2011   Renal continued

Renal Disease   Acute Renal Failure Sudden loss of kidney’s ability to function -leads to a loss of ? Occurs due to heart failure or shock or urinary tract obstructions

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

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?

-too little energy leads to protein breakdown 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

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

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)

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  

Renal Disease Acute Renal Failure Treatment Nutrition Potassium 2-3 grams per day-generally speaking Phosphorous- restrict if hyperphosphatemia

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

Chronic renal failure Causes Include blood lipids, diabetes, hypertension

Chronic renal failure Treatment Energy -too little energy leads to protein breakdown -blood urea and potassium up   -30-35 kcal/kg body weight/day -less on peritoneal dialysis- glucose load -table 28-5 Rolfes et al

Protein Chronic renal failure Treatment -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

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?  

Chronic renal failure Treatment Sodium and Fluids -restrict as loss of renal function progresses -prevents edema, hypertension and heart failure   -needs governed by person’s weight, blood pressure, urinary output and electrolyte levels

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  

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

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

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)

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