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GOALS
Acute
Glomerulonephritis
Due to the deposition of
immune complexes in the
glomerulus
1. Reduce
nitrogen levels
3. Spare CHON
for tissue repair
2. Reduce
BP/edema
ENERGY
HIGH CALORIE
DIET (35kcal/kg BW)
60% CHO
30% Fat
Chronic
Glomerulonephritis
2. Prevent/treat
edema
If with proteinuria:
replace the losses,
please
MAINTAIN GOOD
NUTRITIONAL
STATUS (2000
3000kcal/day)
1. Provide
adequate calories
to spare proteins
2. Reduce
severity of edema
3. Improve serum
albumin and
control
malnutrition
FATS/FLUIDS
Fluids
If edema is mild, no
need for restriction.
Severe cases of
edema: give 500ml
for insensible losses
CHON: 40 60g/day
Impending uremia:
30 40g or
0.5g/kgBW (HBV
proteins)
3. Maintain
optimal nutrition
state
Nephrotic Syndrome
SSx:
Heavy proteinuria
Hypoalbuminemia
Anasarca/edema
Hyperlipidemia/lipiduria
(low CHON triggers the
body to use lipids for
energy instead)
VITAMINS/MINERALS
(+) edema/HPN: restrict Na
intake to 2 3 g daily
4. Improve renal
fx and prevent
complications
5. Kids: avoid
growth retardation
1. Prevent/treat
uremia
PROTEIN
RESTRICT!
CHON: 0.6g/kgBW
Protein restriction is
NOT recommended
in CHON
malnutrition,
neoplasm, &
infections
1.0g/day of HBV
CHONs for EACH
gram of urinary
CHON loss (easy
peasy, 1 is to 1 :D)
Kids: Just give them
their RDA
Fat
30% of total calories
(same as acute GN
again!)
Use linoleic acid
(lowers LDL, raises
HDL) and omega 3
fatty acids (lowers
TAGs by inhibiting
LDL & HDL
synthesis)
Ca chloride: 1 2g/day
To prevent negative Ca
balance, hypoCa, tetanic
convulsions w/ ACTH tx
4. Control
lipidemia
1. Maintain
optimal nutritional
status
2. Reduce
accumulation of
uremic toxins
3. Correct fluid
electrolyte
imbalance
4. Support tissue
healing
5. Control
infection
35 50kcal/kgABW
To provide (+)
nitrogen balance
under stress of ARF,
to spare proteins
0.5 0.6g/kgABW
(not less than
40g/day)
Increase as GFR
normalizes
(+) dialysis: 1
1.5g/kgABW/day
Sodium
Anuric oliguric
phase: 500 1000mg/day
Diuretic phase:
replace losses based
on urinary Na levels,
edema and freq of
dialysis
Potassium
Tissue destruction can
cause K overload
AO phase:
1000mg/day
D phase: same as Na
Phosphorus & Ca: if
needed
Anuric
oliguric phase:
replace output
+ 500ml from
previous day
Diuretic phase:
large amounts
of fluid
Fat
No modification
LALALA - LALA
Chronic Renal Failure
Uremia (prolonged
azotemia + constellation
of clinical signs &
biochemical
abnormalities)
1. Maintain
optimal NS &
stimulate px well
being
2. Provide
adequate energy
intake
3. Regulate
CHON intake to
minimize uremic
toxicity, prevent
CHON
catabolism,
provide for growth
of kids, retard
progression of RF
4. Regulate fluid
intake to balance
fluid output
(regulate Na and
K)
5. Provide vitamin
& mineral supp
Adequate to maintain
or achieve DBW and
prevent CHON catab
= 35kcal/kgBW/day
(if youll notice, its
almost the same as
energy rqmt in acute GN
and ARF:D)
Kids: 100kcal/kgBW
(ideal); 80kcal/kg
(realistic)
HIGHLY
INDIVIDUALIZED!
Stage 1 CRF:
No diet
restrictions yet
but if w/ HPN
limit Na and
caloric intake
Stage 2 CRF:
STRICT diet
modifications
Nephrolithiasis
Characterized by renal
colic, hematuria, stone
formation
1. Prevent
recurrence in
calculi prone px
2. Identify
predominant
components and
modify diet based
on it
3. Increase
secretion of salts,
dilute urine ->
increase fluid
volume to at elast
2L per 24 hours
Stage 4 CRF:
Nutrients strictly
monitored
Acid ash diet
Found in
cranberries,
plums, prunes,
meat, bread
Alkaline ash
Milk, fruit,
veggies
Choice between the
two will depend on
stone composition
Cofactor in
carboxylation
reactions
Increase Ca to 1 3
g/day
Restrict phosphorus
from 45 65mEq
(700 1000mg/day)
Ca oxalate stones:
Restrict Ca to
<1000mg
Less vitamin D
1. Prevent
deficiency and
maintain good
nutritional status
2. Control edema
& electrolyte
imbalance
HIGH FLUID
INTAKE! (8OZ
hourly while awake)
Cystine stones:
Low cystine,
methionine, cysteine
diet
Usually hereditary
Alkalinize urine w/ D
penicillamine
Patients on Dialysis
K restriction
HD:
30 35 kcal/kg
DBW/day (weight
maintenance).
25 30 (weight
reduction),
40 50 (weight gain)
Assess ability to
handle Na and
water frequently
Hemodialysis (HD)
Na: 2000
3000mg/day
Fluid: 500
LALALA - LALA
3. Prevent/retard
devt of renal
osteodystrophy
4. Enable px to
eat a palatable
attractive diet
PD:
25
35kcal/kgDBW/day
(maintenance)
30 50
kcal/kgDBW/day
(repletion)
20 25 (reduction)
35 if (+) DM
Ca, Phosphorus, Vitamin
D
Control intake to
avoid aggravation of
disease
(hypoparathyroidism,
phosphate retention,
hypocalcemia)
Start supplementation
of Ca early to prevent
hyperparathyroidism
Phosphate intake
lowered (use of PO4
binding resins
Amphogel
Calcium
HD: 1000 1800mg/day
PD: same as for
hemodialysis
Phosphorus
HD: <17 mEq or 800
1200mg/day; keep serum
level at max of 4
6mg/100ml
PD: < less than
hemodialysis;
~1200mg/day
Keep serum level at max of
6mg/100ml
Vitamin D
Give when hypocalemia is
severe or causing
osteomalacia
Phosphate binders:
impt during admin of
large doses of Vit D
Routine drug is
available as calcitriol
(Rocaltrol)
Give vitamin supplements!
750ml/day + daily
urine output (~ 750
1500ml/day)
Peritioneal dialysis
(PD)
Na: individualized
based on BP &
weight
Fluid: ~ 2000
3000ml/day for
continuous dialysis;
if intermittent: same
as for hemodialysis