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Chapter 20 – Diseases of the Renal System
Chapter Outline
I. Introduction
II. The Kidneys
A. Normal Anatomy
B. Normal Physiology
C. Diagnostic Procedures – Box 20.1 Estimating Glomerular Filtration Rate (GFR)
III. Nephrotic Syndrome
A. Definition
B. Epidemiology
C. Etiology
D. Clinical Manifestations
E. Treatment
F. Nutrition Therapy – Table 20.1 Dietary Recommendations in Nephrotic Syndrome
IV. Chronic Kidney Disease
A. Definition – Table 20.2 Stages of CKD
B. Epidemiology
C. Etiology – Box 20.3 How Does Diabetes Lead to CKD?
D. Pathophysiology
E. Treatment
1. Box 20.4 Roles and Responsibilities of the Health Care Team in a Diaylsis Unit
F. Nutrition Therapy
1. CKD Stages 1 and 2
2. CKD Stages 3 and 4
a. Table 20.3 Biological/Laboratory Indices in Nutrition Assessment in CKD
b. Box 20.5 Protein Equivalent of Total Nitrogen Appearance (PNA)
c. Table 20.4 Nutrient Recommendations for Stages 3 & 4 CKD
d. Box 20.6 National Renal Diet
3. Evaluation/Outcome Measurement – Table 20.6 Clinical and Patient Behavioral Outcomes in CKD
4. CKD Stage 5
a. Nutrition Assessment
1. Table 20.7 Nutritional Indicators, Target, and Frequency for Stage 5 CKD
2. Box 20.7 Causes of Malnutrition in CKD Patients
b. Nutrition Intervention
1. Table 20.8 Summary of Daily Nutrient Recommendations for HD and PD Patients
2. Protein
3. Energy – Box 20.8 Calculation of Glucose Absorbed in PD Patients
4. Adjusted Edema-Free Body Weight (aBWef)
5. Fat – Table 20.9 Therapeutic Lifestyle Changes for Patients with CKD
6. Potassium – Box 20.9 High- and Low-Potassium Food Guide
7. Fluid and Sodium
a. Table 20.10 Tips to Control Fluid Intake
b. Table 20.11 Low-Sodium Diet
8. Phosphorus
a. Table 20.12 High-Phosphorus Foods to Limit
b. Box 20.10 Sodium and Phosphate Additives in Foods
c. Table 20.13 Phosphate-Binders
9. Calcium
10. Vitamin Supplementation
a. Table 20.14 Daily Vitamin Recommendations for HD and PD Patients
11. Mineral Supplementation
G. Nutrition Therapy for Comorbid Conditions and Complications
1. Cardiovascular Disease – Table 20.15 Dialysis-Related Causes on Inflammation in CKD
2. Secondary Hyperparathyroidism (SHPT)
3. Anemia – Table 20.16 Serum Iron Parameters
H. Medicare Coverage for Medical Nutrition Therapy
I. Nutritional Requirements of the Post Transplant Patient
1. Table 20.17 Nutrition Guidelines for Adult Kidney Transplant Patients
2. Protein and Energy Needs
3. Carbohydrate
4. Fat
5. Sodium
6. Potassium
7. Immunosuppressants
8. Cardiovascular Disease
9. Hypomagnesemia
10. Obesity
11. Calcium, Phosphorus, and Altered Bone Mineral Metabolism
12. Rejection
V. Acute Renal Failure
A. Definition
B. Epidemiology and Etiology
C. Pathophysiology
D. Clinical Manifestations
1. Electrolytes
2. Blood Urea Nitrogen and Crreatinine
E. Treatment
F. Nutrition Therapy
1. Nutrition Implications
a. Trace Minerals and Vitamins
b. Triglycerides
2. Nutrition Interventions
VI. Nephrolithiasis
A. Definition
B. Epidemiology
C. Treatment
D. Box 20.11 Urinary Tract Infections
E. Nutrition Therapy
VII. Conclusion