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Causes of Acute Renal Failure 1. PRERENAL:decreased blood to kidneys severe dehydration - hypovolemia major surgery, hemorrhage, n/v, burns decreased circulating.

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Presentation on theme: "Causes of Acute Renal Failure 1. PRERENAL:decreased blood to kidneys severe dehydration - hypovolemia major surgery, hemorrhage, n/v, burns decreased circulating."— Presentation transcript:

1 Causes of Acute Renal Failure 1. PRERENAL:decreased blood to kidneys severe dehydration - hypovolemia major surgery, hemorrhage, n/v, burns decreased circulating volume sepsis,  cardiac output, CHF, MI obstruction of blood flow to kidney renal artery stenosis

2 Causes of Acute Renal Failure 2. INTRINSIC: (within the kidney) acute tubular necrosis: cell death due to shock, sepsis, open heart surgery nephrotoxic: drugs (abx), dye, Hg, cisplatin, solvents-methanol acute glomerulonephritis lupus, poststreptococcal infection

3 Causes of Acute Renal Failure 3. POSTRENAL OBSTRUCTION:(after kidney) urinary tract obstruction prostate hypertrophy carcinoma of bladder, prostate, cervix know the cause of ARF : nutritional therapy will depend of cause - dialysis may be needed until kidney function returns

4 ARF: Nutritional Therapy know cause: sepsis, trauma, surgery, cancer will  needs -unable to meet at first well nourished 40 y.o ARF due to dye angioplasty vs 40 y.o. with AIDS ARF due to sepsis & hypovolemia balance catabolic needs with possible inability to excrete wastes

5 ARF: Nutritional Therapy example: 55 kg patient with ARF (oliguric) with dialysis: 55 x 1.1-1.4 g pro, 1000cc, 35- 40 kcal/kg - dry wt, 2 g Na p.o. - 2 g Na, 2 g K, 1000 cc Tube feeding product: 2 kcal cc,  Na &K supplements will depend on length of ARF, cause of renal failure & health of pt

6 ARF: Nutritional Therapy without dialysis: 55 x.8 g pro, <1000cc, 35-40 kcal/kg dry wt, 1-2 gm Na, 1-2 gm K p.o. - 40 g pro, 2 g Na, 2 g K, 750 cc Tube feeding product: 2 kcal cc,  Na &K Kayexalate - used to treat K > 5.5 mEq/L glucose, insulin, bicarbonate drive K into cells; cell breakdown causes  K

7 Acute Renal Failure Very sudden drop in glomerular filtration rate - normal GFR = 125ml/min oliguric or nonoliguric generally occurs in healthy kidney & usually reversible associated with critical illness so mortality rate is high

8 Polynephritis Polynephritis = Urinary Tract Infection - chronic: cranberry juice (conc. tannins or proanthocyanins) found to inhibit adherence of E coli to epithelial cells of urinary tract Drink Cranberry Juice! – Other anthocyanins may be protective?

9 Kidney Stones Formed when the concentration of components in urine reach level of crystalization - calcium salts, uric acid, cysteine prevention: rigorous hydration Nurse’s Health Study: drink > 2.5 L/day  risk 38% vs drink <1.4 L/day

10 Chronic Renal Failure Progressive, slow development - yrs vs days deficiency in # of functioning nephrons dx - determine GFR or creatinine clearance when GFR is 25% normal, Cr  & BUN  Low protein diet delays azotemia as CRF advances, remaining nephrons hypertrophy with  in function

11 End Stage Renal Disease (ESRD) Causes: DM (34%) & HTN (30%) 90% nephrons destroyed, GFR 10% normal, Cr Clearance 5-10 ml/min, oliguric, uremia, weakness, n,v, itching, muscle cramps, metallic taste, BUN 100 & Cr 10-12 mg/dL protein recommendations (60% HBV) GFR: 25-55 mL/min 0.6g/kg/day GFR: >55 mL/min 0.8g/kg/day

12 ESRD: Medical Management & Nutritional Care Transplantation: immunosupressive therapy steroids, OKT3, cyclosporin etc counseling to  risk for HTN, wt gain hyperlipidemia, sodium retention, glucose intolerance, 1200 mg Ca, fish (longer graph survival) ? enhance immunosupressives

13 ESRD: Medical Management & Nutritional Care Hemodialysis create fistula to allow person’s blood supply to leave body & filter through semi-permeable membrane of artificial kidney waste products removed by diffusion takes about 3-4 hrs - 3 days week requires special diet

14 ESRD: Medical Management & Nutritional Care Peritoneal Dialysis or CAPD (24 hr/day) uses semipermeable membrane of peritoneum - catheter is surgically implanted into peritoneal cavity high dextrose conc infused (4-5 x day for 20 min) into cavity & exchanged with Na, K, N end prod kcal absorbed from glucose

15 Outcomes of Nutrition Therapy with Dialysis maintain good nutritional status in adults & adequate growth in children control edema & electrolyte imbalance prevent anemia - Epogen enable person to eat palatable, attractive selection of foods that fits lifestyle

16 Prevent Renal Osteodystrophy reciprocal relationship serum P  & Ca  with  GFR, serum P  when serum Ca , PTH released to  Ca & P absorption &  Ca & P release from bone & healthy kidney excretes P (but dialysis does not remove P) meanwhile  1,25-(OH) 2 D 3 prevents normal absorb Ca & so  serum Ca

17 Prevent Renal Osteodystrophy demineralization of bone results - osteomalacia osteitis fibrosa cystica-dull aching bone pain serum Ca x serum P >70=metastatic calcification thus need high Ca and low P diet but many high Ca foods are high in P

18 Nutrition Therapy with Dialysis out-pt procedure payors: Medicare or MediCal requires RD, RN, SW services includes assessment, monthly monitoring of labs with counseling based on lab values teach exchange list - National Renal Diet - this monitors protein, energy, Na, K exchanges: milk, nondairy sub., meat,starch, vegetable, fruit, fat, high kcal, salt

19 Mg=atomic wt x meq valence Meq = mg x valence atomic wt K: atomic wt: 39 & valence:1 Na: atomic wt: 23 & valence:1 2 gm K = 2000 mg = 51 meq 2 gm Na = 2000 mg = 87 meq

20 Potassium Intake with Dialysis Usual (non-dialysis) intake K: 3-4g HD: based on labs restrict to 2-3 g don’t eat foods with >250 mg K/serv: sweet potatoes, baked potatoes, avocado, nuts, bran cereals, tomato prod, salt substitutes K leaches out in water so  K with soaking, rinsing, boiling in water (potatoes) limit f & v - 6 choices/day total

21 Sodium intake with dialysis Usual (nondialysis) : 5-10 g/day HD: restrict to 2-3 g/day CAPD: restrict to 4 g/day teach label reading avoid: luncheon meats, salted meats, processed cheese, pickels & pickeled items, condiments (ketchup, mustard, salad dressing, soy, hot, steak sauce) canned soup, sauerkraut, spices with salt

22 Phosphorus Intake with Dialysis high values major problem! HD: 800-1200 mg/ CAPD: 1200 mg phosphate binders swallowed with each meal: calcium carbonate, Alternajel, Amphojel & Basaljel contain Al  phosphorus foods = milk (110 mg/ 4 oz) cottage cheese (250 mg/1/2 cup) mozz cheese (105 mg/oz) & animal flesh (65 mg/oz)

23 Protein Intake with Dialysis HD: 1.1 - 1.4 g/kg/day CAPD: 1.2 - 1.5 g/kg/day limit intake of milk, cheese, yogurt – why??? encourage HBV unsalted meats, poultry,fish why HBV??? low albumin associated with  mortality rate why is a low albumin commonly seen in persons with ESRD on HD???

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