Ashley Hayslip Nutr 409 3/25/14 Case Study 18 1.

The physiological functions of the kidneys include regulation of fluid, electrolytes, and solute balance. Kidneys filter blood of waste products for excretion. Through the renin-angiotension system, blood pressure is regulated. Activates vitamin D into calcitriol. It also produces erythropoietin. 2. Conditions and risk factors that can lead to chronic kidney failure (CKD) are diabetes, hypertension, age, gender, and certain ethnicities. Both diabetes and hypertension can increase glomerular pressure, causing damage to the kidneys. 3. Stage 1: There is kidney damage, but still works Stage 2: Decreasing GFR, mild decrease in kidney function Stage 3: Moderate decrease in kidney function Stage 4: Severe decrease in kidney function Stage 5: Kidney failure. Transplant/treatment needed. a. Symptoms include proteinuria, azotemia, decreasing GFR, oliguria, muscle weakness, malnourishment, anemia, N/V, and edema. 35 kcals/kg- Patient needs adequate amount of calories in order to spare protein which is lost during renal replacement therapy that she scheduled to have. 1.2g protein- Patient needs higher protein due to what will be lost during dialysis. 2 g K: Patient’s potassium levels are already high because it is not being filtered out of the blood. Restriction is needed when blood levels are increased. 1 g Phosphorus- phosphorus always needs to be restricted because dialysis does not filter and remove it very easily. 2 g Na: a low sodium diet is required to decrease water retention. 1000 mL fluid + urine output: Pt needs to avoid fluid overload, which can lead to increased blood pressure and weight gain. 7. BMI: 33.2 (obese) Edema can give inaccurate weight and BMI. A dry weight is needed in order to accurate interpret body composition and needs. Actual weight of patient is most likely lower than 170#. 8. 165 + (65-165) X.25)=140#. Edema free weight is the weight without the excess fluid that builds up between dialysis treatments.

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12. Protein needs for predialysis patients are considerably lower compared to hemodialysis and peritoneal dialysis patients. Protein needs are much high for patients on dialysis because the dialysate removes protein from the blood. 13. Mrs. Joaquin is on a low phosphorus diet because her kidneys no longer can filter phosphorus out of her blood, nor is the dialysis treatment able to remove phosphorus as well as other waste products. Foods high in phosphorus include animal protein, dairy, nuts, whole grains, and legumes. 14. Foods high in fluids are soups, ice creams, yogurt, and custards. To help control thirst, Mrs. Joaquin can try chewing on ice chips, chew gum, and avoid high sodium foods which increase thirst. 15. GFR indicates the function of the kidney and how well they process waste. A normal GFR is greater than 90 mL/min. Mrs. Joaquin’s is extremely low, which is indicative of damaged kidneys. 16. Patient’s BUN is very high at 69 mg/dL. Low sodium levels 130mEq/L. High potassium 5.8 mEq/L. Very high glucose 282 mg/dL. Low calcium 8.2 mg/dL. High phosphate 9.5mg/dL. High cholesterol 220mg/dL

18. Medication Capoten/ Captopril

Indications/Mechanism Treats high blood pressure and congestive heart failure

Nutritional Concerns Want to take with a low sodium diet.

Erythrppoietin

Is a glycoprotein which stimulates red blood cell production Used to make the urine less acidic. This effect helps the kidneys get rid of uric acid, thereby helping to prevent gout and kidney stones Is a combination of B vitamins used to treat or prevent vitamin deficiency due to poor diet, certain illnesses

Sodium bicarbonate

Renal caps

Renvela

Hectorol

Glucophage

Lowers the amount of phosphorus in blood of patients receiving kidney dialysis. Lowers high levels of parathyroid hormone in the body in kidney dialysis patients. Doxercalciferol is a form of vitamin D. Used with diet and exercise to control blood sugar in patients with type 2 diabetes. May be used alone or with other medicines.

19. Pima Indians have a high rate of obesity and diabetes (and many of their complications are caused by diabetes). Thrifty gene theory is a genetic change that allowed the population to adapt to alternating periods of feasts and famine. This adaptation developed the gene that became more efficient at storing fats during periods of starvation. 22. Protein sources that have HBV are those that have complete essential amino acids required by the human body. They are easily absorbed and more bioavailable to the body. Sources include: meat, poultry, fish, eggs, yogurt, and cheese. These proteins are easier to process by the kidneys and produce less waste.