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Sodexo DI
keep levels of electrolytes stable, such as sodium, potassium, and
phosphate. The kidneys also produce the hormones erythropoietin and
calcitriol, as well as the enzyme renin.
3. Describe the following diseases of the kidneys and identify the
main principles of treatment:
a. Chronic Glomerulonephritis inflammation of the glomeruli;
control high blood pressure or underlying disease such as lupus
or infection
b. Hypertensive Nephropathy chronic hypertension that damages
the blood vessels, controlling blood pressure to prevent further
kidney damage; eventually leading to dialysis
c. Nephrotic Syndrome protein is present in urine, decreases
albumin; maintain adequate protein levels, low sodium diet
d. Polycystic Kidney Disease a genetic disease characterized by
cysts filled with water-like fluid present on the kidneys; do well
with kidney transplants
e. Pyelonephritis kidney infection or UTI that affects the kidneys;
treated with antibiotics, may cause permanent kidney scars
leading to CKD
f. Systemic Lupus Erythematosus (SLE) an autoimmune disease
in which the body's immune system mistakenly attacks healthy
tissue; can cause inflammation in the kidneys
4. In a table format, describe the differences diet and treatment
for acute, chronic and end stage renal disease.
Diet
Treatment
Acute
Protein: <0.8
g/kg body weight
(short duration),
up to 1.4 g/kg
body weight
(catabolic state)
Kcal: 20-30
kcal/kg body
weight/day
Sodium
restriction
Chronic
Protein: <0.6 g/kg
body weight
(close to 0.8 g/kg
to keep lean body
mass), 10% of
calories preserves
kidney function
and reduces
albuminuria
Phosphorous: 812 mg/g
protein/day
Renal Module
Monitor
hydration
status
Vasodilators
Possibly
Angiotensin
blockers
Control blood
pressure
Glycemic
ESRD on HD
Protein: 1.2-1.4
g/kg body weight
Sodium: 2-3 g/day
Potassium: 2-3
g/day based on
protein level
Phosphorus: 8-12
mg/g protein/day
(1200 mg/day)
Calories: 30-35
kcal/kg body
weight
Fluid: 500-750
ml/day + urine
output x 24 hours
(32-40 oz; 10001200 ml)
Hemodialysis
Peritoneal
dialysis
Renal
transplantation
2
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dialysis
control
Protein
restriction
Smoking
cessation
Management
of obesity
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10.
How is fluid allowance determined for patients on
hemodialysis?
This is based on fluid gains and urine output. Generally, patients are
allowed 32-40 oz or 1000-1200 mL/day.
11.
How much weight gain is allowed for hemodialysis
patients between dialysis treatments?
Ideally, 2-3 kg is acceptable. Up to 4 kg is able to be removed during
hemodialysis.
12.
What causes muscle cramping in dialysis patients? What
dietary advice can be given to a dialysis patient to prevent
muscle cramping?
Cramping is caused by too much fluid removal or the rate of fluid
removal being too high trying to remove fluid before the fluid moves
into the vascular space.
13.
What percentage of protein prescribed for renal patients
should be of high biological value?
>50% of protein should be HBV protein.
14.
Why is the diet more liberalized with patients on
peritoneal dialysis compared to hemodialysis?
The diet is more liberalized because they are getting more dialysis
which removes more protein and potassium. PD patients in general do
not need to restrict potassium. Albumin can be low due to protein
removal. Most PD patients still need to use binders.
15.
Renal Module
Sodexo DI
18.
What is metastatic calcification? What lab
measurements should be monitored to prevent metastatic
calcification?
Vascular calcification is when blood vessels become rigid due to
calcium deposits. This can affect all organs, cardiac function, and blood
circulation which can cause wounds. Calciphylaxis is a severe
widespread form of calcification with non-healing wounds. The labs
that should be monitored are PTH, calcium, phosphorous, and alkaline
phosphatase.
19.
An elevated alkaline phosphatase level may indicate
what?
Elevated alkaline phosphatase levels indicate bone disease.
20.
Medication
Amphogel
Aranesp
Chromagen
Citracal
Dialyvite
Diatx
Epogen
Drug Name
aluminum
hydroxide
epoetin alfa
ferrous salts
calcium citrate
N/A
N/A
epoetin alfa
Feosol
ferrous salts
Ferrlecit
Fosrenol
ferrous salts
lanthanum
Hectorol
calcitriol
bismuth
subsalicylate
N/A
N/A
ferrous salts
ferrous salts
Kayexalate
Nephrocaps
Nephrovite
Niferex
Nu-iron
Renal Module
Indication
Oral, IV or
both
oral
IV
oral
oral
oral
oral
IV
antihyperkalemia
multivitamin for dialysis
multivitamin for dialysis
antianemic
antianemic
oral
oral
oral
oral
oral
oral
IV
oral
both
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Oscal
Phoslo
Renagel
(Renvela)
Renax
calcium carbonate
calcium acetate
oral
oral
sevelamer HCl
N/A
oral
oral
Rocatrol
calcitriol
Sensipar
Venofer
cinacalcet
ferrous salts
Zemplar
calcitriol
both
oral
IV
both
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Renal Module
Sodexo DI
more calories are absorbed from the solution. CCPD is continuous PD
which takes about 8 hours and is done using a machine.
2. List the available concentrations of exchanges used and calculate
the calories provided by each.
Available concentrations are 1.5%, 2.5% and 4.25%. 1.5% provides 51
kcal/L, 2.5% provides 85 kcal/L, and 4.25% provides 145 kcal/L. In CAPD
60-76% of calories are absorbed and in CCPD 40-50% of calories are
absorbed.
3. How is teaching a diabetic patient in this area different than in
the HD unit? Include differences in educational materials used
and influences other than diet that affect blood glucose level.
Glucose absorption from the PD dialysate may contribute to excess caloric
intake, weight gain, and high blood sugars. Possibly recommend low carb
or carbohydrate consistent diet.
4. Patients on PD often complain of early satiety. What suggestions
can you give them?
An appetite stimulant may be appropriate. Small, frequent meals
throughout the day can increase protein-energy intake. Drinking fluids
between meals.
5. A female patient, 66 years old, develops peritonitis and is
admitted to the hospital. She is 52 and weighs 125 lbs.
Calculate her protein and calorie needs (do not include calories
from PD exchanges).
56.8 kg * 30 kcal/kg = 1704 kcal * 1.15 factor for peritonitis = 1960 kcal
56.8 kg * 1.5 g/kg pro = 85 g pro
6. Albumin levels are often low in PD patients. What are some of the
possible causes and what educational plans can you develop for
them?
Albumin levels are often low because PD removes more protein from the
body than HD averaging 8 g/day protein losses. 1.2-1.3 g/kg protein is the
recommended intake. There is also more risk for inflammation or infection.
Educational materials can include high sources and amounts of protein.
Renal Module