Renal Diseases (Acute & Chronic) Lecture Notes PDF

DIET THERAPY 2 LECTURE 2 Dr. Mohamed Ahmed Naeem  RENAL DISEASES (ACUTE & CHRONIC) URINARY SYSTEM: IT CONSISTS OF THE KIDNEYS, URETERS, ‫ حالب‬URINARY BLADDER ‫ مثانة‬AND URETHRA ‫مجري البول‬. THE KIDNEYS ARE LOCATED IN THE BACK OF THE BODY, BELOW THE LUNGS. THE URINARY BLADDER IS LOCA...

DIET THERAPY 2 LECTURE 2 Dr. Mohamed Ahmed Naeem  RENAL DISEASES (ACUTE & CHRONIC) URINARY SYSTEM: IT CONSISTS OF THE KIDNEYS, URETERS, ‫ حالب‬URINARY BLADDER ‫ مثانة‬AND URETHRA ‫مجري البول‬. THE KIDNEYS ARE LOCATED IN THE BACK OF THE BODY, BELOW THE LUNGS. THE URINARY BLADDER IS LOCATED IN THE LOWER PART OF THE ABDOMEN FROM THE FRONT Kidney diseases: 1- acute inflammation of the kidneys and urinary bladder 2- salts (stones)in the kidneys or urinary bladder or ureters 3- chronic inflammation of the kidneys 4- hereditary or congenital diseases) 5- kidney failure 6- dialysis (hemo – pretonual ) The kidney is made up of a number of units called nephrons: 1 filters ‫ مرشحات‬to get rid of extra materials from the body 2 receptors ‫ مستقبالت‬to reabsorb the materials the body needs.  The filtration process requires a huge amount of blood, so about 20% of the blood leaving the heart goes into the renal tissue. The filter ‫ المرشح‬contains (water - glucose - amino acids – salts: Na - K - Mg - CL, phosphate+ S + urea, uric acid and creatinine. (99% of the water - all amino acid - glucose - and a large part of the salts and uric acid and half of the urea) are reabsorbed while, creatinine is not absorbed. Potassium can be excreted or absorbed  FUNCTIONS OF THE KIDNEY 1- Maintaining the fluid and salt balance in the body by excreting and reabsorbing their components through the filter. 2 Extraction of toxins in the blood (uric acid - creatinine - ammonia) resulting from protein metabolism, so these toxins pass from the kidneys through the ureters to the bladder and are excreted with urine. 3- The kidneys extract ‫صالختسا‬about 1-2 liters of urine per day. 4It secretes the erythropoietin hormone, which regulates the production of red blood cells in the bone marrow. 5It produces the active form of vitamin D (1-25-dihydroxycalciferol), which helps in the absorption of Ca. 6 It secretes the renin hormone that affects blood pressure.  DIAGNOSIS 1- Doing a complete urine analysis for the patient 2- Plain x-rays on the urinary tract. :‫وجود بروتين‬ ‫مرض بالكلي‬ 3 - X-ray dye on the urinary tract. :‫وجود دم بالبول‬ ‫وجود التهاب بالكلي‬ ‫والمجري البولي‬ 4 - Making sound waves. :‫وجود صديد‬ ‫وجود عدوي بالبكتيريا‬ 5- kidney functions, GFR.  PATIENTS WITH DIGESTIVE PROBLEMS CAN BE FED PARENTERAL NUTRITION. AND THE LEVEL OF GLUCOSE IN THE BLOOD MUST BE MONITORED IN THESE PATIENTS, AS THERE IS INSULIN RESISTANCE IN THE BODY AS A RESULT OF THE CATABOLIC PROCESSES ASSOCIATED WITH THE DISEASE. 1- ACUTE RENAL FAILURE (ARF)  It is a sudden decrease in the filtering rate of the kidneys ( 125 ml/min to 30 ml/ min), and therefore their inability to get rid of harmful products, and the degree of failure in the patient’s kidneys varies. Among the most important symptoms that may appear together or scattered are: 1- higher temperature. 2- A tremor or an uprising 3- Severe headache 4- Vomiting. 5- Severe pain in the back. 6-Pain and difficulty urinating and sometimes blood or albumin in the urine 7-Impaired mood and loss of appetite  CAUSES OF THE DISEASE 1A severe deficiency in the volume of blood circulation resulting from blood loss, as in accidents, heavy bleeding, surgeries, or lack of plasma, such as in burns. 2Loss of body fluids from the digestive system (dehydration), which may occur as a result of severe diarrhea or persistent vomiting, through the urine (as in the case of a diabetic coma), or through the skin (excessive sweating) which may occur in people with sun stroke. 3 As a result of acute infection of kidney. 4Taking some medications that have a toxic effect on the kidneys, or some antibiotics that damage liver and kidney cells, or taking some chemical compounds and pesticides.  COMPLICATIONS As a result of acute kidney failure, a sudden decrease in the glomerular filtration rate (GFR) occurs, and consequently, a decrease in the amount of urine occurs and changes in the components of urine and blood that may lead to: 1collection of nitrogenous compounds in the blood (urea - creatinine - uric acid). ). 2High level of potassium in the blood due to the inability of the kidneys to excrete it in the urine, thus increasing the chance of the patient suffering from sudden heart failure. 3Oedema may occur in the lung due to the inability of the kidneys to excrete fluid, and this occurs especially for the elderly, and high blood pressure may occur as a result. 4Delayed wound healing, infection, muscle loss, and negative nitrogen balance  REQUIREMENTS Total energy = 30 -50 cal/kg Body weight Fats: 30% Proteins: 0.8- 0.6 g/kg BW This amount depends on The extent of the efficiency of the kidneys and the metabolic rate as well as the nutritional status of the patient In severe cases in which the level of urea in the blood increases, the amount of protein intake must be reduced, and with the improvement of the patient’s condition, it must be raised to reached Normal RDA  FLUID AND MINERALS BALANCE The amount of fluid taken is adjusted according to the volume of urine output, as it is given in an amount equal to (the volume of urine in the past 24 hours + (500: 700 ml). Note: If urine retention occurs, the amount of fluid intake must be reduced. While the quantity increases when The use of diuretics. Decreasing Na as much as possible (2500 mg/day) and determining potassium (1500 - 3000 mg / day).  RECOMMENDATIONS FOR PATIENTS WITH ACUTE RENAL FAILURE: 1- reduce the intake of fresh vegetables and fruits because they contain high amounts of potassium. 2 It is necessary to reduce the amount of phosphates in food. (eggs, milk and cheese) as alternatives to meat 3 Not to be exposed to the sun for long periods, especially the intense sun, or to make a muscular effort so as not to cause severe sweating, which makes the patient obliged to increase the volume of fluids that he is indispensable. 4 Do not overindulge in soft drinks. 4- Do not put salt in food preparation to prevent high blood pressure. 5- To reduce the amount of salt in vegetables (boiling vegetables and wash twice after boiling). 6 You should avoid eating canned food due to the high percentage of sodium in it, which are added as preservatives such as sodium benzoate. 7Meat is served to the patient boiled without soup water. 8- Limit eating dairy. 9- Determining the amount of sodium in food. 2- CHRONIC RENAL FAILURE  IN MOST CASES OF CHRONIC KIDNEY FAILURE, A LARGE NUMBER OF NEPHRONS ARE DESTROYED, AND THE REST IS NOT ENOUGH FOR THE KIDNEY TO DO ITS WORK, AND MOST OFTEN IT IS THE RESULT OF KIDNEY INJURY FOR A LONG PERIOD OF TIME.  CAUSES 1Glomerulonephritis ‫ التهاب الكلي‬: Infection with microbes leads to an imbalance in the body's immune system to form antigens, and as a result, the body creates antibodies to leak the product into the glomeruli membranes of the kidneys. 2Urinary tract obstruction, such as the presence of stones in the ureter or bladder. 3- High blood pressure and diabetes: A small percentage of cases of blood pressure and diabetes end with kidney injury, an injury that leads to kidney failure. But human infection with high blood pressure or diabetes, leads with the passage of time to narrowing of the arteries feeding the kidney and thus atrophy occurs in the cortex area of the kidney, which leads to the injury of the kidneys to chronic renal failure 4- excessive usage of drug: Excessive use of medications and analgesics in particular (their use for a long time and in high doses) is one of the most important causes of kidney failure, as it affects the kidney marrow, which flows into the kidney basin, which leads to its death. The most important drugs that cause kidney failure are: Analgesic drugs, rheumatism drugs, some antibiotics, special dyes used in radiology, drugs used to treat cancer, drugs used in anesthesia. 5- Chronic nephritis: It usually occurs as a result of urine rising to the ureter (as a result of a congenital defect that can be treated surgically, or if urine is deliberately held several times and for long periods) causing microbial infections that in turn destroy the kidney pelvis tissue and marrow and the matter ends with kidney failure. WHAT ARE THE SYMPTOMS AND SIGNS OF ILLNESS? The patient may not feel any symptoms for a long time, but the most important symptoms associated with the disease are: 1- Feeling tired and exhausted, both physically and mentally 2- Decreased appetite, 3 difficulty breathing 4 Itching, 5 The patient may also develop anemia or high blood pressure and inflammation in the peripheral nerves (numbness) and as a result of vitamin D deficiency in its active form, the patient develops softness in the bones.  DIAGNOSIS 1 Kidney functions : - Blood urea Creatinine Uric acid 2 urine analysis 3 GFR  THE GOAL OF TREATING CHRONIC KIDNEY FAILURE 1 Delaying the progression of the disease 2Giving an adequate amount of calories helps in maintaining weight 3It prevents the appearance of urea in the blood 4- Maintains the chemical balance in the body 5Reducing the amount of proteins (found in eggs, meat and legumes) and replacing them with sugars, starches or fats 6Reducing the amount of table salt and potassium (found in nuts, bananas, oranges and grapefruit)  RDA 1- Proteins : 0.5 – 0.6 GRAM/KG BW, THE LOWEST RDA REACHES TO 0.3 GRAM/KG BW TO ENSURE THAT THE BODY GETS AN ADEQUATE PROPORTION OF THE ESSENTIAL AMINO ACIDS. THERE IS NO PROBLEM FOR REDUCING THE RATE OF PROTEIN IN FOOD UNLESS THE RATE OF KIDNEY WORK FALLS BELOW 40 ML / MINUTE, THEN THE PROTEIN DECREASES IN MEALS AND THE  2- ENERGY: 35 cal/kg BW 3- Fats : 25-30 % of total calories ( there is no hyperlipidemia) 4- Carb: 55-60 % 5- Sodium if there is urine retention, edema or high blood pressure, Na (2500 mg) should be specified. It is known that water contains a large proportion of potassium, so distilled water should be used for drinking and cooking for patients with kidney failure.  POTASSIUM The affected kidneys cannot excrete potassium, so the potassium intake must be maintained so that it does not exceed 1500- 3000 mg/ day Milk (240 gram): 340 potassium Meat (30 g): 120 mg Vegetables : 240 mg Fruits : 130 mg Bread: 25 mg Fats : zero  VITAMINSNS Usually a need for vitamins occurs due to - the limitation of food proteins, - the absorption capacity of the gastrointestinal tract in patients with chronic renal failure decreases, - harmful nitrogenous compounds interfere and reduce the activity of some vitamins, so vitamin B complex and vitamin C must be given as doses. additional. And give iron in the form of tablets  HOME WORK Case: Gender: Male Status : acute renal failure Height : 170 cm Age: 45 year Weight: 113 kg Activity: moderate ‘day diet for the patient