1. 2:45-3:15 PM on Thursday (28 th November). Meet with quality assurance external reviewers for the school of professional studies. Nutrition transfer student volunteers please email me and Marcy MacKinnon marcy_mackinnon@cbu.ca indicating whether you are year 1 or 2 and with you willingness to do so- your help is very much required and appreciated. Thank you!!!

2. Winter 2013

3. Final exam 15 questions-short answer-point form covering whole term 5 Q on diabetes and atherosclerosis 10 Q on blood pressure, stroke, and kidney disease-10 points each- 3 hours-no choice on questions

4. The Lecture 12- 26 November 2013 KIDNEY DISEASE

5. Outline of todays talk I.Pathology II.Socioeconomic factors contributing to ESRD III. Elementary nutritional approaches to be taken to avoid and treat ESRD including foods available to those at risk IV.First Nations and other Cape Breton individuals at risk V.How is nutritional assessment made for kidney disease? VI. How would one assess from a nutritional perspective the socioeconomics, pathology and success of nutritional interventions relative to ESRD?

6. Kidney Disease I.Pathology Types of Kidney Disease glomerular disease nephrotic syndrome nephritic syndrome

7. Kidney Disease I.Pathology Types of Kidney Disease glomerular disease nephrotic syndrome -loss of glomerlular barrier to protein nephritic syndrome -inflammation of capillary loops of glomerulus

8. Kidney Disease I. Pathology Types of Kidney Disease Diseases of the tubules and interstitium acute renal failure pyelonephritis nephrolithiasis Focus on end stage renal disease

9. Kidney Disease I. Pathology Types of ESRD Diseases of the tubules and interstitium acute renal failure sudden reduction in glomerular filtration rate-pre-, intrinsic and post- renal flow drops pyelonephritis nephrolithiasis

10. Kidney Disease I.Pathology Diseases of the tubules and interstitium pyelonephritis-urinary tract infection nephrolithiasis-kidney stones

11. End stage renal disease (ESRD) I.Pathology End-stage renal disease inability to produce waste products, maintain fluid, and electrolyte balance and produce hormones diabetes

12. ESRD I.Pathology End-stage renal disease-associations diabetes (types I and II) glomerulonephritis hypertension

13. End stage renal disease I. Pathology What are the risk factors? End-stage renal disease Obesity and all its sequelae leading to metabolic syndrome genetics and dietary risk factors for type I diabetes

14. End stage renal disease I. Pathology What are the risk factors? Glomerulonephritis infection- immune system requires adequate balanced nutrition

15. End stage renal disease I. Pathology What are the risk factors? Hypertension -damages tissues -all causes of hypertension

16. Socioeconomic factors Food and hence nutritional choices depend on: Personal preference-protective factors(preventative)-absence is a risk factor type I and type II diabetes-review infection-review hypertension-review

17. Socioeconomic factors Food and hence nutritional choices depend on: Habit type I and type II diabetes-review infection-review hypertension-review

18. Food and hence nutritional choices depend on: Ethnic heritage or tradition type I and type II diabetes-review infection-review hypertension-review Social interaction relate social interaction to ethnic heritage or tradition

19. Food and hence nutritional choices depend on: Availability of food type I and type II diabetes-review infection-review hypertension-review Convenience of food type I and type II diabetes-review infection-review hypertension-review

20. Food and hence nutritional choices depend on: Economy of food type I and type II diabetes-review infection-review hypertension-review

21. Food and hence nutritional choices depend on: Positive and negative associations type I and type II diabetes-review infection-review hypertension-review

22. Food and hence nutritional choices depend on: Emotional conflict type I and type II diabetes-review infection-review hypertension-review

23. Food and hence nutritional choices depend on: Values-how does this apply to: type I and type II diabetes-review infection-review hypertension-review

24. Food and hence nutritional choices depend on: Body image type I and type II diabetes-review infection-review hypertension-review

25. Food and hence nutritional choices depend on: Advertising-who is responsible for encouraging or not encouraging type I and type II diabetes-review infection-review hypertension-review

26. BREAK

28. More on socioeconomic factors Prestige -occupational- lower the occupation the greater the risk of ESRD-why? low occupational fathers tend to have low or lower occupational kids could be a number of generations before population end-stage renal disease risk is reduced

29. More on socioeconomic factors Prestige -occupational- higher the occupation the less the risk of ESRD-why? high occupational fathers tend to have high or higher occupational kids could be a number of generations before population ESRD risk is increased among descendants of initial high occupational fathers

30. More on socioeconomic factors Prestige -societal perceptions-dictate ability of people to change their social rankings -education-eg university professors and astronauts have a lot of sophisticated education and they are rated highly-however this is no guarantee that there is no risk of ESRD

31. More on socioeconomic factors Power-based on societal perceptions to some extent Income-also based on societal perceptions of the importance of the job to society

32. More on socioeconomic factors Wealth-based on education-lower classes tend to be less well educated and therefore less able to take advantage of the societal perceptions that improve one’s socioeconomic status including wealth Education- lower classes tend to be less well educated and therefore less able to take advantage of the societal perceptions that improve one’s socioeconomic status including the benefits arising from that education

33. More on socioeconomic factors Social stratification -ancestry-diabetes, infection, blood pressure -gender-diabetes, infection, blood pressure -race- diabetes, infection, blood pressure -ethnicity- diabetes, infection, blood pressure

34. More on socioeconomic factors Social stratification -mobility-diabetes, infection, blood pressure -mental and physical activity- mental patients-may be marginalised by society-what impact does this have on the risk of ESRD? physical activity

35. More on socioeconomic factors Social stratification physical activity-ESRD risk lowered by chronic aerobic activity-caution with elevated blood pressure- blood pressure increases during aerobic exercise - benefit with exercise comes after blood pressure is lowered in rest and during exercise- this is a training effect

36. More on socioeconomic factors Social stratification physical activity-impact on type I and II diabetes -impact on infection

37. More on socioeconomic factors Class -uppers -lower uppers -upper middles -average middles -working class -lower class How might each of these classes have an impact risk or presence of ESRD?

38. More on socioeconomic factors Global economy-globalisation- impact on: type I and type II diabetes-review infection-review hypertension-review Government-nutrition policies affect risk of ESRD-how? type I and type II diabetes-review infection-review hypertension-review

39. More on socioeconomic factors Business-promotion of globalisation-why would business promote globalisation? Psychology-susceptibility to business tactics such as?- impact on the risk of ESRD? History-one’s habits and childhood socioeconomic status

40. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Planning a healthy diet To do this bear in mind Adequacy Balance Energy control Nutrient density Moderation Variety

41. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Prevention-eat foods in accordance with: type I and type II diabetes-review infection-review hypertension-review

42. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Post-onset-eat foods in accordance with type I and type II diabetes-review infection-review hypertension-review

43. BREAK

44. IV. First nations and other Cape Breton individuals at risk. Aboriginals Retired Unemployed Genetics Others?

45. How is nutritional assessment made for ESRD-prevention and cure? Nutrient intake analysis type I and type II diabetes-review infection-review hypertension-review

46. How is nutritional assessment made for ESRD-prevention and cure? Nutrient intake analysis FLUID-WHY? SODIUM-WHY? POTASSIUM-WHY? CHLORIDE-WHY? GLUCOSE-WHY? CALCIUM-WHY? PHOSPHOROUS-WHY?

47. How is nutritional assessment made for ESRD- prevention and cure? Daily food record/Diary what are potential problems with this approach regarding ESRD?

48. How is nutritional assessment made for ESRD-prevention and cure? Retrospective data -24 hour recall -food frequency questionnaire both 24 hour recall and are used to cross check one another-how would this apply to ESRD

49. How is nutritional assessment made for ESRD-prevention and cure? Anthropometry- type I and type II diabetes-review infection-review hypertension-review

50. How is nutritional assessment made for ESRD--prevention and cure? Nutrition focussed physical exam: type I and type II diabetes-review infection-review hypertension-review

51. How is nutritional assessment made for ESRD-prevention and cure? Skin testing-applicable type I -review infection-applicable? hypertension-applicable?

52. How is nutritional assessment made for ESRD-prevention and cure? Biochemical analysis type I and type II diabetes-review infection-review hypertension-review

53. How is nutritional assessment made for ESRD--prevention and cure? Biochemical analysis FLUID-WHY? SODIUM-WHY? POTASSIUM-WHY? CHLORIDE-WHY? GLUCOSE-WHY? CALCIUM-WHY? PHOSPHOROUS-WHY?

54. How is nutritional assessment made for ESRD-prevention and cure? CLASSIFYING MALNUTRITION obesity is the main issue here thin individuals are much less at risk than obese persons

55. VI. GROUP DISCUSSION-HOW WOULD ONE ASSESS FROM NUTRITIONAL PERSPECTIVE THE SOCIOECONOMICS, PATHOLOGY AND SUCCESS OF NUTRITIONAL INTERVENTIONS RELATIVE TO ESRD ?