Diet and Renal Disease
ObjectivesDescribe work of kidneys in general termsDiscuss common causes of renal diseaseExplain why the following are sometimes
restricted for renal clients:ProteinSodium and waterPotassium and phosphorus
KidneysExcrete wastesMaintain volume and composition of body
fluidsSynthesize and secrete certain hormones as
neededFilter blood and remove or recycle waste
products
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KidneysMaintain fluid, acid-base, and electrolyte
balanceNephrons
Working partsGlomerulus
Filtering unit
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KidneysUreters transport liquid waste materials from
kidneys to bladderWaste materials:
End products of protein metabolism, excess water and nutrients, dead renal cells, and toxic substances
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KidneysOliguria:
Urinary output less than 500 mL per dayKidneys unable to adequately eliminate waste
products Can result in renal failure
Renal DiseasesPossible causes:
Infection, degenerative changes, diabetes mellitus, cardiovascular disorders, cysts, renal stones, or trauma
Can result in renal failure
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Renal DiseasesAcute renal failure
Occurs suddenlyMay last a few days to a few weeksCan be caused by another medical problem
E.g., serious burn, crushing injury, cardiac arrest
Chronic kidney diseaseDevelops slowly with number of functioning
nephrons diminishing
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Renal DiseasesChronic kidney disease
Uremia Condition in which protein wastes not excreted
Instead, circulated in blood Symptoms:
Nausea, headache, coma, and convulsions
Severe renal failure can result in death unless dialysis used
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Renal DiseasesNephritis
Inflammatory disease of kidneysCaused by infection, degenerative processes,
or vascular diseaseGlomerulonephritis
Inflammation affecting capillaries in glomeruli
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Renal DiseasesNephrosclerosis
Hardening of renal arteriesCaused by arteriosclerosis and hypertensionUsually occurs in older clients
Sometimes develops in younger clients with diabetes
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Renal DiseasesPolycystic kidney disease
Relatively rare hereditary diseaseCysts form
Press on kidneysKidneys enlarge
Lose functionRenal failure may develop
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Renal DiseasesNephrolithiasis
Stones develop in kidneys Classified according to composition
Associated with metabolic disturbances and immobilization of client
Dietary Treatment of Renal DiseaseGoals:
Slow buildup of waste in bloodReduce work of kidneyMaintain fluid, acid-base, and electrolyte
balanceSufficient calories and protein necessary to
prevent malnutrition
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Dietary Treatment of Renal DiseaseEnergy requirements should be fulfilled by
carbohydrates and fat to spare proteinMetabolized protein increases amount of
nitrogen waste kidneys must handleProtein allowance based on glomerular
filtration rate and weight
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Dietary Treatment of Renal DiseaseSodium and fluids may be limited to prevent
edema, hypertension, and CHFCalcium and vitamin D supplements may be
prescribedPhosphorus may be limited if retained
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Dietary Treatment of Renal DiseaseHyperkalemia may occur in end-stage renal
disease (ESRD)Potassium may be restricted
Renal clients often have increased need for vitamin B, vitamin C, and vitamin DSupplements often given
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Dietary Treatment of Renal DiseaseIron commonly prescribed to treat or prevent
anemia
DialysisHemodialysis
Requires permanent access to bloodstream through fistula
Treat three times per week for three to five hours each time
Peritoneal dialysisUses peritoneal cavity for accessLess efficient than hemodialysisUsually treat three times per week for
approximately 10 to 12 hours per day(continues)
DialysisContinuous ambulatory peritoneal dialysis
(CAPD):Exchanges fluid four to five times dailyComplications:
Peritonitis, hypotension, and weight gain
Diet during DialysisMust carefully control protein intake
75 percent should be high biological valuePotassium usually restrictedTypical renal diet could be written as “80-3-
3”80 g protein, 3 g sodium, and 3 g potassium
daily
Diet after Kidney TransplantNeed for extra protein or for restriction of
proteinCarbohydrates and sodium may be restrictedAdditional calcium and phosphorus may be
necessary if substantial bone loss before transplant
Stop and ShareConsider the following scenario:
A client with renal disease is on a potassium restriction of 3,000 mg. What recommendations would you give the client?
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Stop and ShareRegulate intake by making careful choicesMilk normally restricted to ½ cup per day
High in potassiumSuggest use of potassium content charts to
select low-potassium foods
Dietary Treatment of Renal StonesVaries based on type of stoneDrink large amount of fluidEat well-balanced dietOnce stones analyzed, specific diet
modifications may be indicated
Calcium Oxalate StonesRisk factors:
Excessive animal protein intakeOxalate
Reduce level of oxalateFound in beets, wheat bran, chocolate, tea,
rhubarb, strawberries, and spinach
Uric Acid StonesRestrict purine-rich foods
Found in meats, fish, poultry, organ meats, anchovies, sardines, meat extracts, and broths
Usually associated with gout, gastrointestinal diseases that cause diarrhea, and malignant disease
Cystine StonesCaused by excessive cystine concentration in
urineDue to hereditary metabolic disorder
Increased fluids and alkaline-ash diet recommended
Struvite StonesComposed of magnesium ammonium
phosphateDevelop following urinary tract infections
caused by certain microorganismsLow-phosphorus diet often prescribed
Considerations for the Health Care Professional
Clients with renal disease have lifelong challenge
Develop trusting relationship with clientHelp motivate clients to learn how to manage
nutritional requirementsHelp dietitian assist clients
ConclusionKidneys eliminate body wastes, secrete
hormones, and maintain fluid, acid-base, and electrolyte balance
Entire body affected by kidney disease
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ConclusionDiet therapy may be extremely complexUntreated, severe kidney disease can result
in deathUnless client receives dialysis or kidney
transplant
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