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The kidney filters approximately $1600$ L of blood per day.
The kidney filters approximately $1600$ L of blood per day.
True (A)
A patient with a GFR of 55 mL/min/1.73m² would be classified as having Stage 3 chronic kidney disease.
A patient with a GFR of 55 mL/min/1.73m² would be classified as having Stage 3 chronic kidney disease.
True (A)
A patient with chronic kidney disease can be classified as having Stage 1 even if their GFR is above 100 mL/min/1.73m².
A patient with chronic kidney disease can be classified as having Stage 1 even if their GFR is above 100 mL/min/1.73m².
True (A)
The kidney's primary function is to regulate the levels of fluids, electrolytes, and organic solutes in the body, maintaining a stable internal environment.
The kidney's primary function is to regulate the levels of fluids, electrolytes, and organic solutes in the body, maintaining a stable internal environment.
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Patients with kidney failure will always have a GFR below 15 mL/min/1.73m².
Patients with kidney failure will always have a GFR below 15 mL/min/1.73m².
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The glomerulus is responsible for filtering blood and preventing the passage of blood cells and protein.
The glomerulus is responsible for filtering blood and preventing the passage of blood cells and protein.
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Continuous Ambulatory Peritoneal Dialysis (CAPD) typically involves 2-3 hour exchange cycles throughout the day.
Continuous Ambulatory Peritoneal Dialysis (CAPD) typically involves 2-3 hour exchange cycles throughout the day.
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The kidney's ability to eliminate nitrogenous waste products is referred to as renal failure.
The kidney's ability to eliminate nitrogenous waste products is referred to as renal failure.
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Hemodyalisis patients typically receive treatment 2-3 times per week, for a duration of 2-3 hours each session.
Hemodyalisis patients typically receive treatment 2-3 times per week, for a duration of 2-3 hours each session.
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The kidneys regulate blood pressure through the production of erythropoietin, a hormone involved in red blood cell production.
The kidneys regulate blood pressure through the production of erythropoietin, a hormone involved in red blood cell production.
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Acute Renal Failure (ARF) is marked by a sudden decrease in the glomerular filtration rate (GFR).
Acute Renal Failure (ARF) is marked by a sudden decrease in the glomerular filtration rate (GFR).
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Increasing carbohydrate intake to above 150g daily reduces protein breakdown by more than 50%.
Increasing carbohydrate intake to above 150g daily reduces protein breakdown by more than 50%.
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The recommended protein intake for non-dialysis patients with chronic kidney disease is between 0.8 and 1.2 g/kg.
The recommended protein intake for non-dialysis patients with chronic kidney disease is between 0.8 and 1.2 g/kg.
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In the early stages of ARF, patients can often eat normally and do not require nutritional support.
In the early stages of ARF, patients can often eat normally and do not require nutritional support.
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Chronic Kidney Disease (CKD) is classified into five stages based on the severity of the condition.
Chronic Kidney Disease (CKD) is classified into five stages based on the severity of the condition.
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The estimated daily calorie needs for a patient with chronic kidney disease are approximately 40-50 kcal/kg.
The estimated daily calorie needs for a patient with chronic kidney disease are approximately 40-50 kcal/kg.
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Individuals on hemodialysis should restrict their daily potassium intake to between 2 and 3 grams.
Individuals on hemodialysis should restrict their daily potassium intake to between 2 and 3 grams.
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A patient on hemodialysis with hypertension and edema may need to restrict their fluid intake.
A patient on hemodialysis with hypertension and edema may need to restrict their fluid intake.
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A patient on hemodialysis should strive for a weight gain of 2 to 3 kg between dialysis sessions.
A patient on hemodialysis should strive for a weight gain of 2 to 3 kg between dialysis sessions.
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The recommended daily sodium intake for most patients on hemodialysis is 2-3 grams.
The recommended daily sodium intake for most patients on hemodialysis is 2-3 grams.
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The energy requirement for an adult on hemodialysis is 15-20 kcal/kg of ideal body weight.
The energy requirement for an adult on hemodialysis is 15-20 kcal/kg of ideal body weight.
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The amount of protein required daily for an adult on hemodialysis is 0.8 g/kg of ideal body weight.
The amount of protein required daily for an adult on hemodialysis is 0.8 g/kg of ideal body weight.
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A patient on hemodialysis who experiences a 65% or greater reduction in serum urea is considered poorly dialyzed.
A patient on hemodialysis who experiences a 65% or greater reduction in serum urea is considered poorly dialyzed.
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Renal osteodystrophy is a common complication of ESRD that can affect calcium, phosphorus, and vitamin D levels.
Renal osteodystrophy is a common complication of ESRD that can affect calcium, phosphorus, and vitamin D levels.
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A serum ferritin level below 100 ng/dL is a hallmark of absolute iron deficiency in patients with Chronic Kidney Disease (CKD).
A serum ferritin level below 100 ng/dL is a hallmark of absolute iron deficiency in patients with Chronic Kidney Disease (CKD).
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A patient on dialysis should limit their intake of dairy products to 2 servings per day.
A patient on dialysis should limit their intake of dairy products to 2 servings per day.
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The recommended target hemoglobin (Hb) level for patients with CKD is between 10.0 and 11.0 g/dL.
The recommended target hemoglobin (Hb) level for patients with CKD is between 10.0 and 11.0 g/dL.
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Folic acid deficiency can cause macrocytic anemia and is often exacerbated by hemodialysis due to the loss of folic acid in the dialysate.
Folic acid deficiency can cause macrocytic anemia and is often exacerbated by hemodialysis due to the loss of folic acid in the dialysate.
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A TSAT greater than 20% and a serum ferritin level above 200 ng/dL are recommended targets for iron supplementation in hemodialysis patients to ensure adequate iron stores for erythropoiesis.
A TSAT greater than 20% and a serum ferritin level above 200 ng/dL are recommended targets for iron supplementation in hemodialysis patients to ensure adequate iron stores for erythropoiesis.
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The recommended daily intake of fruits, vegetables, and juices for dialysis patients is restricted to eight servings.
The recommended daily intake of fruits, vegetables, and juices for dialysis patients is restricted to eight servings.
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Epoetin and Darbepoetin are erythropoiesis-stimulating agents that have significantly improved the treatment of anemia in dialysis and CKD patients.
Epoetin and Darbepoetin are erythropoiesis-stimulating agents that have significantly improved the treatment of anemia in dialysis and CKD patients.
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A patient on dialysis should limit their fluid intake to prevent a weight gain exceeding 3.0 kg between treatments.
A patient on dialysis should limit their fluid intake to prevent a weight gain exceeding 3.0 kg between treatments.
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As the GFR decreases, phosphorus is retained in the plasma due to its renal excretion being enhanced.
As the GFR decreases, phosphorus is retained in the plasma due to its renal excretion being enhanced.
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Patients with ESRD commonly experience glucose intolerance with hyperglycemia but not hypoglycemia.
Patients with ESRD commonly experience glucose intolerance with hyperglycemia but not hypoglycemia.
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Anemia is less prevalent in stage 4 CKD compared to earlier stages.
Anemia is less prevalent in stage 4 CKD compared to earlier stages.
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The World Health Organization defines anemia as a Hb level of less than 14 g/dL for men.
The World Health Organization defines anemia as a Hb level of less than 14 g/dL for men.
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Erythropoietin is insufficiently produced due to factors including the bone marrow's decreased response to oxygen delivery.
Erythropoietin is insufficiently produced due to factors including the bone marrow's decreased response to oxygen delivery.
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Calcium intake is generally kept low in order to mitigate the impacts of hyperparathyroidism in renal failure.
Calcium intake is generally kept low in order to mitigate the impacts of hyperparathyroidism in renal failure.
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Iron deficiency is the least significant contributor to anemia in chronic kidney disease compared to other factors.
Iron deficiency is the least significant contributor to anemia in chronic kidney disease compared to other factors.
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Levels of fat-soluble vitamins typically show greater fluctuations than water-soluble vitamins in patients with renal disease.
Levels of fat-soluble vitamins typically show greater fluctuations than water-soluble vitamins in patients with renal disease.
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Study Notes
Medical Nutrition Therapy in Kidney Disease
- Medical nutrition therapy is crucial in managing kidney diseases, including acute renal failure (ARF) and chronic kidney disease (CKD).
- The kidney’s primary functions are excretory, endocrine, and metabolic.
- Kidney function can be affected by conditions such as ARF and CKD, leading to potential nutritional imbalances.
Kidney Anatomy
- The kidneys receive 20% of cardiac output.
- This allows for the filtering of roughly 1600 liters a day of blood.
- Only 1.5 liters of urine are excreted daily.
- Each kidney contains one million nephrons.
- Nephrons consist of a glomerulus, loop of Henle, distal tubule, and collecting duct.
- The glomerulus filters blood, excluding blood cells and protein.
- Tubules reabsorb most components in the ultrafiltrate.
- The kidney regulates water homeostasis.
- Main waste products are urea, uric acid, creatinine, and ammonia.
- The kidney's ability to eliminate waste is renal function.
Acute Renal Failure (ARF)
- Characterized by a sudden reduction in glomerular filtration rate (GFR).
- Nutritional care is vital, as patients often experience uremia, metabolic acidosis, and physiological stress.
- Total parenteral nutrition (TPN) and early dialysis are often used in early stages.
- TPN and early dialysis can positively affect patient survival.
Chronic Kidney Disease (CKD)
- CKD has five stages, categorized by GFR levels.
- CKD stages are divided based on the GFR.
- The GFR measurements classify various levels of CKD.
Nutritional Goals for ESRD (End-Stage Renal Disease) patients on Hemodialysis
- Prevent deficiencies and maintain good nutritional status.
- Adequacy of protein, energy, vitamins, and minerals is vital.
- Control edema and electrolyte imbalances by regulating sodium, potassium, and fluid intake.
- Prevent or delay renal osteodystrophy by managing calcium and vitamin D intake.
- Enable patients to eat palatable and attractive diets appropriate to their lifestyle.
Nutritional Requirements for Dialysis Patients
- Energy needs: 30-40 kcal/kg of ideal body weight.
- Carbohydrate intake (100g over 24 hours) reduces protein breakdown by 50%.
- Protein intake: Non-dialysis - 0.5-0.8 g/kg; Dialysis -1-2 g/kg ideal body weight. A significant portion should be high biological value protein.
- Fluid intake is often restricted to avoid weight gain.
Fluid and Sodium Balance
- The kidney's ability to handle sodium and water needs to be frequently assessed.
- Assessing aspects include blood pressure, edema presence, sodium dietary intake, and serum sodium levels,
- Sodium Intake (g/day): 2-3.
- Dialysis patients with hypertension and edema may need restricted sodium and fluid intake.
- Patients should be guided to manage thirst without excessive fluid intake.
- Weight gain from fluid should be limited to 2-3 kg.
Potassium
- Potassium restriction is often necessary, depending on factors such as individual body size, serum potassium levels, urine output, and dialysis frequency.
- Daily intake ranges from 3-5 grams, and is usually reduced to 2-3 grams in ESRD on dialysis.
Vitamin Supplements
- Water-soluble vitamins are often lost during dialysis; levels of fat-soluble vitamins remain relatively stable.
- Vitamin K supplements should generally be avoided, given patient use of anticoagulants.
Anemia in CKD
- Anemia in CKD and ESRD patients is a frequent complication.
- Causes include erythropoietin deficiency, iron deficiency, folate and vitamin B12 deficiency.
- Anemia can be assessed via HB levels.
- Recommended HB levels are 11.0–12.0 g/dL generally.
Calcium, Phosphorus, and Vitamin D
- Metabolic bone disease (renal osteodystrophy) is a significant complication in ESRD.
- Serum phosphorus levels increase as glomerular filtration rate (GFR) declines.
- To avoid complications, calcium and phosphorus intake are individually controlled with diets.
Dietary Considerations
- Typical food options include limiting dairy intake to one serving daily, and limiting fruits, vegetable, and juices to six servings per day.
- Examples of food to limit include milk, nondairy creamer, alternatives, eggs, toast, muffins, bagels, fruit, snacks (sandwiches, cookies, crackers), certain beverages, and cold or hot cereal.
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Description
This quiz covers key concepts related to medical nutrition therapy for managing kidney diseases like acute renal failure and chronic kidney disease. It explores the anatomy and functions of the kidneys, emphasizing their role in excretion, metabolism, and maintaining nutritional balance. Test your knowledge on kidney health and nutrition strategies.
