What are renal calculi? What diet would be ordered for a patient with this condition? Is this similar to or different from the recommendations for end-stage renal failure?
A renal calculi is a kidney stone. Renal caculi are solid masses made up of chemicals that are normally found in the urine. A patient with a kidney stone could remain on the same diet, however they will need to consume between 2 to 3 quarts of water a day in order to help pass the kidney stone. This is different than the diet of a patient with end stage renal failure, because in end stage renal failure fluid intake is more limited. A person with end stage renal failure on hemodialysis will be placed on a diet that matches fluid to urinary output plus 1000 cc.
What is nephrotic syndrome? What diet would be ordered for a patient with this condition? Is this similar to or different from the recommendations for end-stage renal failure?
Nephrotic syndrome is a disorder of the kidneys in which large amounts of protein are excreted in the urine. A person with end stage renal failure on dialysis requires a higher amount of protein than a patient with Nephrotic Syndrome because protein is lost during hemodialysis. Unlike a person on hemodialysis, a patient with Nephrotic Syndrome does not need to limit their potassium or phosphorus intake. They do however need to maintain sodium in a similar range to that of a patient with Nephritic Syndrome. In addition, it is recommended Nephrotic Syndrome patients are placed on a diet that increases soluble fiber intake and limits saturated fat, trans fat, and cholesterol intake.
How is “dry” weight of a patient on dialysis determined? What dietary factor would be impacted the most by a patient’s daily weight versus dry weight?
The dry weight of a patient on dialysis is determined by measuring the patient after the dialysis treatment. Fluid consumption will impact a patients daily weight more so than their dry weight.
Besides diabetes, what are some common causes of renal failure?
Diabetes, high blood pressure, and glomerulonephritis are the most common causes of renal failure.
Describe the clinical symptoms of a patient with chronic renal failure.
Patients with chronic renal failure exhibit the following clinical symptoms: protein is present in the urine due to the kidneys inability to properly filter protein; elevated serum creatinine indicate poor kidney function because Creatinine is not being filtered properly; elevated BUN (blood urea nitrogen) also indicates kidney dysfunction; and creatinine clearance and GFR are also decreased in chronic renal failure.
Indicate normal values for healthy individuals and accepted values for dialysis patients for each of the following:
- BUN Normal Values: 6-20mg/dL
- BUN Dialysis Values: 40-60 mg/dL
- Creatinine Normal Values: Male: 0.7-1.3 mg/dL; Female: 2.6-6.0 mg/dL
- Creatinine Dialysis Values:
- K+ Normal Values: 3.5-5.1 mEq/L
- K+ Dialysis Values: 3.5-5.5 mEq/L
- Ca++ Normal Values: 8.5-10.5 mg/dL
- Ca++ Dialysis Values: 8.5-10.5 mg/dL
- Phosphorous Normal Values: 2.5-5.0 mg/dL
- Phosphorous Dialysis Values: 3.5-5.5 mg/dL
- Hematocrit Normal Values: Male: 39-49%; Female: 35-45%
- Hematocrit Dialysis Values: 33-36%
- Hemoglobin Normal Values: Male 13.5-17.5 g/dL; Female 12.0 – 16.0 g/dL
- Hemoglobin Dialysis Values: 11-12 g/dL
- Triglycerides Normal Values: < 200 mg/dL
- Triglycerides Dialysis Values: < 150 mg/dL
In chart format, briefly discuss the use of the following drugs. Include classification, indication and contraindication for use with the renal patient, effect of the drug on nutrient absorption and utilization, effect of nutrients on drug absorption and utilization.
|Drug||Classification||Indication||Contraindication||Drug Effect||Nutrient Effect|
|Prednisone||Corticosteroid||Anti inflammatory, immunosuppressant||Lactation, peptic ulcer, diabetes||Increases Na, Decreases K, Decreases Ca, Decreases Zn, decreases Vit C, Decrease Vit A|
Grapefruit and citrus juices can decrease effectiveness
|Kayexalate||Sodium polystyrene sulfonate||Antihyperkalemia||Obstructive bowel disease, severe constipation or hypokalemia||Decreases Na||Binds with K and inhibits K removal. Drug should not be consumed with K rich foods.|
|Phos-Lo||Phosphate binder||Anti-inflammatory, immunosuppressant||Hypercalcemia||Decreased iron absorption.||Increases serum calcium levels|
|Solumedrol||Corticosteroid||Anti-inflammatory, immunosuppressant||Systemic fungal patients, and patients with known hypersensitivity||Increases Na, Decreases K, Decreases Ca, Decreases Zn, Decrease Vit C, Decrease Vit A|
|Erythropoietin||Epoetin Alfa||Antianemic||Fe, B12 or Fol def anemia, hemolysis, uncontrolled HTN or GI bleeding||Decreases Fe|
|Oscal||Calcium Carbonate||Mineral supplement, phosphate binder, antacid||Hypercalcemia, hypercalciuria, hyperparathyroidism, bone tumors||Increases Ca, Decreases phosphorus|
Define high biological value protein and discuss the rationale for its use with renal patients. List foods that contain high biological value protein.
Foods that are of high biological value contain all eight essential amino acids. They are also referred to as complete protein. Consumption of foods high in biological value are recommended for renal patients in order to ensure that protein foods are utilized for their amino acid content and not for merely calories. Foods that contain high biological value include: meat, poultry, fish, dairy, and soy foods.
Describe the clinical rationale for a protein restricted diet for a patient with renal failure not on dialysis.
Renal patients suffer from an inability to properly filter blood because of damage to the kidneys. Inability to properly excrete protein is common in renal patients and worsens as the function of the kidney deteriorates further. Patients with renal failure not on dialysis are placed on a protein restricted diet in order to minimize proteinuria while meeting protein needs and preventing malnutrition
Discuss vitamin/mineral supplementation for the renal patient.
Patients on dialysis are typically prescribed vitamin/mineral supplements to replace losses during dialysis. Vitamin/mineral supplementation can not include all vitamins/minerals because certain vitamins/minerals are elevated as a result of dialysis. For example, potassium, sodium, and phosphorus are restricted for dialysis patients due to high serum levels. Decreased absorption of calcium, alterations in vitamin D metabolism, and increased phosphorus levels decrease serum calcium levels in renal patients and increase calcium needs. Current vitamin supplements for renal patients include vitamin C, thiamin, riboflavin, niacin, vitamin B6, vitamin B12, folic acid, pantothenic acid, and biotin. Iron deficiency is also common in hemodialysis patients because the kidney is unable to make erythropoietin so many patients require iron supplementation.
Briefly describe the prognosis for a patient who has received a successful kidney transplant.
According to a 2003 study by the United Network for Organ Sharing, a kidney transplant patient after undergoing a successful transplant has a 93% chance of surviving one year after surgery. The probability of living further slowly decreases after each additional year after surgery. For example, according to the same study a kidney transplant patient has 58.9% chance of surviving 10 years after transplant surgery. Transplant patients are at increased risk for developing several co morbidities including CVD and osteoporosis. Although most patients experience a generally better quality of life after transplantation, they require close follow up after transplant and a specific diet.
Briefly describe the prognosis for a patient with chronic renal failure who is being maintained by dialysis and dietary treatment.
Although patients have survived with over 25 years of dialysis treatment, the average life expectancy for a dialysis patient is 4 years. However, life expectancy depends on age and other medical problems that may be present and dialysis patients suffer from a decreased quality of life.
INTERN’S NAME: Melissa Cannon
ROTATION AREA: Renal Disease
CHARTING TYPE: Not specified
PRECEPTOR’S COMMENTS / CORRECTIONS OF CHARTING
Complex scenario/case study in which Melissa shows understanding of its complexity.
INTERN’S COMMENTS ABOUT NUTRITIONAL INTERVENTION(S):
The patient was in a vegetative state and was unable to participate in the nutritional intervention. The patient’s family was also not present. Determining nutrient needs for this patient were complicated because he was overweight, suffering from chronic renal failure, and had pressure ulcers. We ended up keeping the patients nutrient levels similar, but switched the patient to a formula lower in vitamin K. The resulting fluid the patient received was below recommended levels, but the patient’s labs indicated that the patient was not under hydrated and an increase was not necessary.
WAS THE NUTRITION INTERVENTION SUCCESSFUL? WHY/WHY NOT?:
The intervention was successful in that the patient’s vitamin K levels returned to within normal values and the patients other lab values maintained within normal values. The patient continues to have a large weight status. However, Morav (the dietitian I worked with on the case) believed that reducing the patient’s body weight would put unnecessary stress on the patient’s body.