MNT-mnt mnt mnt mnt mnt mnt .Kidney.pptx

Mnt for kidney disease

1. MNT---Kidney diseases Dr. K. S. Abbasi INSTITUTE OF FOOD & NUTRITIONAL SCIENCES

2. kidneys  are two bean-shaped organs found on the left and right sides of the body in vertebrates. They are located at the back of the abdominal cavity in the retroperitoneal space. In adults they are about 11 centimetres (4.3 in) in length. They receive blood from the paired renal arteries; blood exits into the paired renal veins. Each kidney is attached to a ureter, a tube that carries excreted urine to the bladder. Function : Filtering system of the body Help to remove waste material from the body Help to maintain BP, RBC production Balance body fluids

3. Damage factors : OTC drugs----Ibuprofen Certain anti-biotics Less intake of water---current situation in Pakistan High intake of sodium--- Reducing the ability of your  kidneys  to remove the water Alcohol consumption irritates the kidneys and  affects  hormone regulation of  water balance in the body. Risk Factors: 10% of the global population is affected by chronic kidney disease. People of Black African and South Asian descent are 3-5 times more likely to suffer from kidney failure (requiring dialysis)  South Asian patients with diabetes----are 10 times more likely to go on to have kidney failure.  Genetics

4. Kidney (Renal) Stones Renal stones are painful and can cause nausea, difficulty passing urine and may progress to kidney disease if there is a blockage. A high salt diet has been associated with renal stones. Urinary calcium, the main constituent of renal stones, is increased by a high salt diet and this increases the risk of stones. Avoid stone-forming foods: Beets ,  chocolate ,  spinach , tea , and most nuts are rich in  oxalate , and colas are rich in phosphate, both of which can contribute to kidney stones. Pair calcium-rich foods with oxalate-rich foods. Chronic kidney stones are often treated with potassium citrate, but studies have shown that limeade, lemonade and other fruits and juices high in natural citrate offers the same stone-preventing benefits. Eating less animal-based protein and eating more fruits and vegetables will help decrease urine acidity and this will help reduce the chance for stone formation.

5. Calcium stones : Calcium is not the enemy. If you have high calcium in the urine then sodium reduction is helpful for stone prevention. Instead of reducing your calcium intake, focus on limiting the sodium in your diet and pair calcium-rich foods with oxalate-rich foods. Oxalate stones: Oxalate stones: fruits and vegetables, nuts and seeds, grains, legumes, and even chocolate and tea Eating and drinking calcium and oxalate-rich foods  together  during a meal is a better approach than limiting oxalate entirely because oxalate and calcium are more likely to bind to one another in the stomach and intestines before the kidneys begin processing, making it less likely that kidney stones will form.

6. Uric acid stones: Cut down on high-purine foods such as red meat, organ meats, and shellfish, and follow a healthy diet that contains mostly vegetables and fruits, whole grains, and low fat dairy products. Limit sugar-sweetened foods and drinks, especially those that contain high fructose corn syrup. Limit alcohol because it can increase uric acid levels in the blood and avoid crash diets for the same reason. Eating less animal-based protein and eating more fruits and vegetables will help decrease urine acidity and this will help reduce the chance for stone formation. Stone preventions: Reducing the amount of animal protein may help. Sources of animal protein include beef, chicken, fish and eggs. Most people need only four to six ounces of high protein foods and three servings of milk or cheese.

7. Acute kidney Injury (AKI) An abrupt loss of kidney function that develops within 7 days. Acute kidney injury (formerly known as acute renal failure) is a syndrome characterized by the rapid loss of the kidney's excretory function and is typically diagnosed by the accumulation of end products of nitrogen metabolism—Urea and Creatinine level or  decreased urine output, or both Can lead to number of complications, including metabolic acidosis, high K levels, uremia, changes in body fluid balance, even can lead to death. Can increase risk of CKD Management----treatment of underlying cause. Causes : Excessive use of diuretics, side effects of many medications, excessive vomiting, diarrhea, burns, sweating, blood loss, chemotherapy, neurotoxic medications

8. Symptoms Edema, lethargy, confusion, nausea, vomiting, weight gain Urine output Normal  urine output  is 1-2 ml/ kg /hr. To determine the  urine output  of your patient, you need to know their weight, the amount of  urine  produced, and the amount of time it took them to produce that  urine .  Urine output  should be measured at least every four hours if possible.   Oliguria (urine output less than 400 mL per day), Anuria (urine output less than 100 mL per day), or normal volumes of urine (non-oliguric acute kidney injury) Diagnosis: The initial laboratory evaluation should include complete blood count, measurement of serum creatinine level, HbA1C, Albumin, electrolytes, Parathyriod Hormone (PTH). Clinical Management : Patients with acute kidney injury generally should be hospitalized unless the condition is mild and clearly resulting from an easily reversible cause. Hemodynamically stable---normal, heart function, Normal BP and normal urine output

9. Nutritional Management (AKI): From a nutritional point of view AKI can be divided into two groups: AKI in the non-catabolic state Causes includes Dehydration, certain medications and urinary obstruction. Generally stable and where required any renal replacement therapy (RRT) will usually be provided by conventional haemodialysis (HD). Oral diet alone, or with the addition of nutritionally-dense supplementary sip feeds will frequently be sufficient to meet the patients’ needs. If not artificial nutrition support should be implemented. AKI in the catabolic state Causes includes sepsis and trauma, often have multi-organ failure and will be managed on an ICU, complex therapeutic challenges. PEW (protein energy wasting) is a frequent finding and is associated with poorer patient outcomes in terms of length of hospital stay, complications and mortality rates.

10. Protein turnover rates are increased and negative nitrogen balance results. Nitrogen requirements are increased above normal and are also influenced by the mode of RRT undertaken. Although hyper catabolism cannot be reversed by simply increasing protein intake, appropriate nutrition support will reduce nitrogen losses. Patients will usually require artificial nutrition support, particularly if intubated and sedated. Wherever possible, this should be provided via the enteral route. Standard formulae can be used, but nutritionally-dense feeds with or without reduced electrolyte content are useful where the control of fluid balance and/or serum phosphate and potassium levels proves difficult

11. Chronic Kidney disease (CKD) Chronic kidney disease  ( CKD ), also known as chronic renal disease, is progressive loss in kidney function over a period of months or years. The symptoms of worsening kidney function are not specific, and might include feeling generally unwell and experiencing a reduced appetite, Key points: Early detection can help prevent the progression of kidney disease to kidney failure. Heart disease is the major cause of death for all people with CKD. Glomerular filtration rate (GFR) is the best estimate of kidney function. Hypertension causes CKD and CKD causes hypertension. Persistent proteinuria (protein in the urine) means CKD is present. High risk groups include those with diabetes, hypertension and family history of kidney failure. African Americans, Hispanics, Pacific Islanders, American Indians and Seniors are at increased risk. Two simple tests can detect CKD: blood pressure, urine albumin and serum creatinine.

12. CKD and Diabetes: Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure. People with Repeated urinary infections are also at risk of CKD.

13. General Symptoms : feel more tired and have less energy have trouble concentrating have a poor appetite have trouble sleeping have muscle cramping at night have swollen feet and ankles have puffiness around your eyes, especially in the morning have dry, itchy skin need to urinate more often, especially at night.

14. Glomerular Filtration Rate  ( GFR ). A  blood test  measures how much blood  your kidneys filter each minute The blood sample is sent to a lab. There, the creatinine level in the blood sample is tested. The lab specialist combines your creatinine level with several other factors to estimate your GFR. The formula includes some or all of the factors like; age, blood creatinine measurement, ethnicity, gender, height, weight etc. The GFR test is recommended for people with chronic kidney disease. It is also recommended for persons who may get kidney disease due to: People living with Diabetes, frequent UTI, heart diseases, hypertension, family history of kidney disease, urinary blockage

15. General Nutritional Management

16. Mineral nutritional therapy in Kidney disorder Sodium: If kidneys are not working well, sodium and fluid build up in body. This can cause high blood pressure and other problems like swelling of ankles, fingers or eyes. Most processed foods are higher in sodium. Convenience means that many of us end up eating less fresh foods which are important for a healthy diet. Cereals and bread are popular foods that can contain higher levels of sodium so check the label. Cook own meals from whole foods rather than buying processed whenever you can. Eat only small amounts of high sodium foods. Check the ingredients list for hidden salts. Adding herbs and spices to fresh foods are a good way to add flavour without the salt.

17. Phosphorus: Phosphorus is a mineral found in many foods. Large amounts of phosphorus are found in: n dairy products such as: Milk, cheese, yogurt, ice cream and pudding, nuts and peanut butter, dried beans and peas such as kidney beans, split peas and lentils n beverages such as cocoa, beer and dark cola drinks n bran breads and bran cereals Eating high-phosphorus foods can raise the level of phosphorus in blood. Kidneys may not be able to remove all of this extra phosphorus To keep phosphorus at safe levels in blood, you may need to limit phosphorus-rich foods. Patients may also need to take a type of medicine called a phosphate binder. These binders are taken with your meals and snacks. Your doctor will tell you if you need to limit high-phosphorus foods or take phosphorus binders.

18. Potassium Nearly all foods contain some potassium. Many healthy foods like fruits, vegetables and dairy are high in potassium. In kidney disease, intake of these foods often needs to be controlled. This may mean avoiding some fruits and vegetables altogether, while for others a small serve and eating them less often may be enough. The amount of potassium depend on type of dialysis. i.e. Hemodialysis (restrict potassium intake) & Peritoneal dialysis (increase potassium intake), In Pakistan, Hemodialysis is mostly preferred. Limit milk and milk products or replace with nondairy substitutes. Discard liquids from canned fruits and vegetables. Avoid salt substitutes and other seasonings with potassium. Read labels on packaged foods and avoid potassium chloride. Pay attention to serving size. Don’t skip dialysis or shorten treatment times. Leach high-potassium vegetables to remove some of the potassium.

19. High Potassium Low Potassium Bananas Dried fruits Kiwi Mangos Oranges & orange juice Papaya Prune juice Apples Berries Fruit Cocktail (Not suitable for Patients living with Diabetes) Grapes (Not suitable for Patients living with Diabetes) Peaches Canned Pears (Not suitable for Patients living with Diabetes) Pineapple Plums Watermelon High Potassium Low Potassium Dried beans and peas Pumpkin Potatoes Spinach (cooked) Sweet potatoes Tomatoes, tomato sauce Vegetable juices Carrots Cabbage Cauliflower Cucumber Eggplant Green beans Lettuce Onion High Potassium Low Potassium Ice cream Milk Yogurt Soy milk and nondairy creamer, rice milk and almond milk. However these products are not available in Pakistan. Also culturally not acceptable, thus it is better to allow 0.5 to 1 cup of low fat milk or low fat yogurt

20. Fluid restriction therapy in Kidney Disorder Fluid restrictions are usually necessary when dialysis is initiated, especially if dialysis only occurs three days a week and if urine production is decreased.  Build up of fluid can lead to shortness of breath, swelling, and high blood pressure.  There is a limit to the amount of fluid that can be safely removed during dialysis. If fluid limits are exceeded and extra water must be removed, negative effects such as muscle cramping, low blood pressure leading to nausea, weakness, dizziness, and possibly extra dialysis sessions to remove the fluid. Fluid restrictions vary for each individual.  Factors in determining the amount of the restriction include weight gain between treatments, urine output, and swelling.   

21. Fluids are anything that is liquid at room temperature or melts at room temperature. These include water, tea/coffee, milk, soft drinks, juice, ice, ice cream, sherbet, gelatin, soups, liquid creamer, alcohol, water, or beverage used for taking medicine. Limit high salt foods----less thirst. Suggest patients to take pills with mealtime liquids Drink from small glasses and cups. Drink only when feel thirsty. Use sour candy or gum to moisten mouth. Add some lemon juice to water or ice. The sour taste will help to quench your thirst. Use ice cubes instead of liquids-----will last longer. Freeze 20 grapes and eat throughout the day as one of fruit servings.