1. Note

2. Lecture 8c 7 March 2011
Renal continued

3. 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

4. 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

5. 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?

6. -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

7. 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

8. Renal Disease
 Acute Renal Failure
Treatment 
Nutrition
Fluids
-over- or under-hydrated must be addressed - urine output plus ml for water lost though skin, lungs, and perspiration (vomiting diarrhea, fever add more than ml)

9. Renal Disease Acute Renal Failure Treatment Nutrition Sodium
-restrict sodium to 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

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

11. 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

12. Chronic renal failure
Causes
Include blood lipids, diabetes, hypertension

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

14. 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

15. 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?

16. 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

17. 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

18. 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

19. 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

20. 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)

21. 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