1. Causes Lupus Chronic HTN Prolonged Urinary obstruction Nephrotic syndrome PKD Cystinosis Diabetes

2. Lab Evaluation of Kidney Function  Albumin  Glomerular Filtration Rate  Creatinine  BUN  Calcium  Carbon Dioxide  Chloride  CBC  Glucose  Magnesium  Phosphorus  Potassium

3. Treatment Non-Dialysis MNT:  Stages 1-2: Focus on Comorbid conditions-DM, HTN, Hyperlipidemia  Stages 3-4  MNT intervention: Renal Diet

4. HEMODIALYSIS http://www.kidney.niddk.nih.gov

5. Peritoneal Dialysis http://www.kidney-hypertension.com

6. Medications Phosphate binders Hematopoietic Growth Factors Iron Products Calcimimietics Statins

7. Patient Information Admission 7/16/2013 Chief Complaint: Shortness of Breath PMH:  Diabetes  Aortic insufficiency  Chronic Renal insufficiency  Hypothyroidism  Hx Breast CA  CHF, Unknown Ejection Fraction  HTN  Hyperlipidemia  Atrial fibrillation Past Surgical Hx:  Cholecystectomy  Lumpectomy  Arthroscopy  Aortic Valve Replacement  Hysterectomy  Rotator Cuff Repair Social Hx:  No smoking, drug, or alcohol abuse hx

8. Diagnosis: 7/16/13 Impression 1) SOB, pt increased Lasix dose, pt has worsening Crea 2.7 2) Acute on chronic kidney disease stage IV 3) Insulin dependent DM 4) Aortic valve replacement 5) Hypothyroidism 6) Hx of breast CA 7) Hx od DVT 8) HTN, controlled 9) Hyperlipidemia 10) A fib

9. Diet Hx 7/17 diet hx and patient interview Patient reported “Regular, low sodium low potassium, low protein” diet. Interview:  NAS  Avoid potato and banana  Label reading

10. Assessment Medi-Tech Note

11. PES Statement Altered nutrition related labs related to change in ability to absorb and excrete as evidenced by elevated BUN/Crea, low glucose, CKD Stage IV. Altered nutrition related lab values related to kidney dysfunction, as evidenced by BUN^ (56) Crea ^ (2.6), GFR L (19.2), rapid weight changes (4.5# since admission), conditions associated with a diagnosis or treatment related to renal disease.

12. MNT Renal/Diabetic Meal Plan Oneonta Renal Disease chart

13. 7/18 Non-productive cough Output 2.5 L with lasix Crea improvement to 2.3 IV lasix to

14. 7/23 “No deterioration in condition” IV Steroids BUN slowly rising (61) Crea decreasing (2.0) D/d within 48 hours

15. 7/23 Teresa’s note! Patient interview Knowledge base Referral

16. 7/25 “No deterioration in general condition” BUN 71^ Crea 2.3 ^ Glucose 268 Steriod + glucose Dr. Hongalgi on board

17. 7/26 Discharge!

18. Care Plan Interventions  Nutrition education Goals:  Pt to follow a renal/carbohydrate consistent diet order Indicators:  Length of stay: 6 days

19. Monitor Labs Intake

20. Evaluation Were goals met?

21. Thank you!!!! Questions?!

22. Resources 1. Role of a Registered Dietitian in your health care. Cleveland Clinic. http://my.clevelandclinic.org/healthy_living/prevention/hic_the_role_of_a_registered_di etitian_in_your_health_care.aspx. 14 August 2013. Role of a Registered Dietitian in your health care. Cleveland Clinic. http://my.clevelandclinic.org/healthy_living/prevention/hic_the_role_of_a_registered_di etitian_in_your_health_care.aspx 2. Safety and efficacy of drug-eluting stents in older patients with chronic kidney disease," by Thomas T. Tsai, M.D., John C. Messenger, M.D., J. Mathew Brennan, M.D., and others in the Journal of the American College of Cardiology 58(180), pp. 1859-1869, 2011. 3. Nelms M, Sucha K, Lacey K, et al. Nutrition Therapy and Pathophysiology. Belmont, Ca: Wadsworth, Cengage Learning. 2007, 2011. 4. Escott-Stump S. Nutrition and Diagnosis-Related Care. Baltimore, MD. Wolters Kluwer. 2012. 5. "What Is Lupus." Lupus Foundation Of America. N.p., 2013. Web. 14 Aug. 2013. 6. United States Renal Data System. USRDS 2007 Annual Data Report. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services; 2007. 7. Nickel, M.D., J Curtis. "Urinary Retention." National Institute Of Diabetes And Digestive And Kidney Diseases. N.p., 29 June 2012. Web. 14 Aug. 2013.. 8. Dugdale, III, David C., and Herbert Y. Lin, PhD, M.D.. "Nephrotic Syndrome." Medline Plus. National Institute Of Health, n.d. Web. 14 Aug. 2013..

23. 9. "Polycystic Kidney Disease- Overview." FamilyDoctor.org. N.p., 01 Jan. 2011. Web. 14 Aug. 2013.http://familydoctor.org/familydoctor/en/diseases- conditions/polycystic-kidney-disease.printerview.all.htmlhttp://familydoctor.org/familydoctor/en/diseases- conditions/polycystic-kidney-disease.printerview.all.html 10. "Cystinosis." Genetics Home Reference. U.S. National Library Of Medicine, 01 May 2013. Web. 14 Aug. 2013.. 11. Pagana. Manual of Diagnostic and Laboratory Tests. Missouri: Mosby, 2010. Print. 12. Arora, M.D., Pradeep. "Medication Summary." Chronic Kidney Disease Medication. Medscape, 05 Aug. 2013. Web. 16 Aug. 2013..