CHAPTER 23
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glomerulus / filtering
erythropoietin
Glomerulus: a tuft of capillaries within the nephron that filters water and solutes from the blood as urine production begins
*by filtering blood and forming urine, the kidneys regulate the extracelular fluid volume and osmolarity, electrolyte concentrati
treatment of nephrotic
Nephrotic syndrome: a syndrome caused by significant urinary protein losses (proteinuria) that result from severe glumerular damage
*condition arises because damage to the glomeruli increases their permeability to plasma proteins, allowing the proteins to
acute kidney injury - oligoria - what does it lead to?
*Acute kidney injury:
-kidney function deteriorates rapidly, over hours or days
-loss of kidney function reduces urine output and allows nitrigenous wastes to build up in the blood
CUASES:
-usually develops as a consequence of critical illness, sepsis or
treatment of kidney injury- meds , diet, mood, etc
-involves a combination of drug therapy, dialysis, and nutrition therapy to restore fluid and electrolyte imbalances and minimize blood concentrations of toxic waste products
-In oliguric patients, recovery from kidney injury sometimes beings with a perio
uremic syndrome
*Hormonal imbalances: diseased kidneys are unable to produce erythropoietin, causing anemia. Reduced production of active viamin D contributes to bone disease
*Altered heart function/increaswed heart disease risk: fluid and electrolyte imbalances result i
vitamin of CKD - restrictive diet dialysis
why fat in CKD?
TREATMENT
-slow disease progression and prevent or alleviate complications
DRUG THERAPY
-antihypertensive - to treat hypertension
-phosphate bnders to reduce serum phosphate levels, sodium bicarbonate to reverse acidosis, and cholesterol-lowering medicati
CKD why use plant or animal protein?
-50% of the protin should come from high-quality sources
-plant sources should be invluded as they place less demand on the kidneys than animal proteins and are also low in phosphorus
Once dialysis has begun,protein restrictions can be relaxed because dia
foods high in potassium, phosphorus, and oxolates
POTASSIUM more than 250 mg
-avocado, banana, beets, chard, dates, nectarine, orange, parsnips, potatoes, pumpkin, raisins, spinach, sweet potatoes, tomato
150-250 mg
-apple, apricots, asparagus, broccoli, cantaloupe, celery, grapefruit, corn, honeydew, ka
neo vs. paratineal dialysis (which one is liberal)
complications w/ nemo-dialysis
infection and more
Peritoneal dialysis
-removes fluids and wastes from the blood by using the bodys peritoneal membranse as a filter
-vascular access is not required
-dietary restrictions are fewer
-procedure can be scheduled when convenient
Disadvatage
-infectin, which can
NT after kidney transplant
drugs, side effects , dietary restrictions
IMMUNOSUPPRESANT DRUG THERAPY
-to prevent tissue rejection following transplant surgery
-multiple effects: nausea, vomiting, diarrhea, glucose intolerance, altered blood lipids, fluid retention, hypertension and increased infection risk
NUTRITION THERAPY
best dietary advice on kidney stones (prevention)
-advised to drink 12 to 16 cups of fluid daily to produce more than 2 to 2.5 L of urine per day
-patients should consume adequate calcium from food sources, about 800 to 1200 mg a day
-moderate protein consumption, 0.8-1.0 g/kg of body weight
-controlled
calcium oxalate stones, how common?
-most common abnormality in people with calcium oxolate stones = hypercalcuria
-Elevated urinary oxalate levels = hyperoxaluria
-oxalate is a normal product of metabolism that readily binds to calcium
-fat malabsorption can increase oxalate absorption
hyperkalcuria
elevated urinary calcium levels
-results from:
-excessive calcium absorption
-impaired calcium resorption in kidney tubules
-or elevated serum levels of parathyroid hormone or Vit D
metabolic stress (online)
a disruption in the bodys chemical environment due to the effects of disease or injury.
-characterized by changes in metabolic rate, heart rate, blood pressure, hormonal status, and nutrient malabsorption
CHAPTER 24
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defines stress response
-the bodys non specific response to a variety of stressors such as burns, fractures, infection, surgery and wounds
catecholamines
Metabolic effects:
-increase in metabolic rate
-glycogen breakdown in the liver and muscle
-glucose production from amino acids
-release of fatty acids from adipose tissue
-glucagon secretion from the pancreas
eiconisynoids
20-carbon molecules derived from dietary fatty acids that help to regulate blood pressure, blood clotting, and other body functions
identify classic signs of inflammation
-heat - from the influx of warm arterial blood
-redness - from the increase in blood in the injured area
- swelling - from the accumulation of fluid and immune cells at the site of injury
-pain - from the swelling of chemical mediators that stimulate pain
emphysema vs bronchitis
EMPHYSEMA
-characterized by the breakdown of the lungs elastic structure and destruction of the walls of the bronchioles and alveoli
-changes that significantly reduce the surface area available for respiration-
CHRONIC BRONCHITIS
-characterized by persis
sirs - what is it? charactersitics
-systemic inflammatory response syndrome
-if inflammation does not resolve, the continued production of pro-inflammatory cytokines may lead to this
-diagnosed when the patients symptoms include:
-substantial increases in heart rate and respiratory rate
-a
MODS
what is it?
organs affected?NP24-2 risk factors
-Multiple Organ Dysfunction syndrome
-the progressive dysfunction of two or more of the bodys organ systems
-most often involves lungs, kidneys, and liver
-last stage of severe illness or injury that results from a severe inflammatory response
RISK FACTOR
CHAPTER 25
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nutrition related factors influence cancer = risk affect
-various food components can alter processes of DNA repair, gene expression, or cell differentiation
-obesity is a risk factor:
-alters the leveld of hormones
-red meat: colon, rectum
-salted and salt preserved foods: stomach
-beta carotene supps: lung
-h
female nutrition related to factors cancer
-breast cancer in post menopausal women, the hormone estorgen is involved
-obese women have higher estrogen levels than lean women do because adipose tissue is the primary source of estrogen after menopause
-the increase in circulating estrogen may create
meds that combat anorexia and wasting in cancer
-meds prescribed to stimulate the appetite and promote weight gain include megestrol acetate and synthetic compunds similar in structure to the hormone progesterone
-dronabinol resembles the psychoactive ingredient in marijuana and stimulates the appetite
HIV
-acquiered immuno deficiency syndrome
-develops from infection with HIV which attacks the immune system and disables a persons defenses against other diseases
wasting syndrome and characteristics of HIV
-wasting has been linked with accelerated disease progressio, reduced strength, and fatigue
-Causes: anorexia and inadequate food intake, nutrient alabsorption, altered metabolism, and various diet-drug interactions
-Oral infections
-cancer
-respiratory d
kaposis sarcoma - why is it important
-a common cancer in the cancer and HIV infected persons that is characterized by lesions in the skin, lungs, and GI tract
-can cause lesions in the mouth and throught and make eating painful
how to control anorexia and wasting in HIV patients
-anabolic hormones, appretite stimulants and regular physical activity have been succesful in reversing unintentional weight loss and increasing muscle mass in HIV patients
-testosteron and human growth hormone have demonstrated positive effects on muscle
lipodystrophy
what is it
parts of boy affected
-many people who use drug therapies tosuppress HIV infection develop abnormalities in body fat and fat metabolism
-patients may loose fat from the face and extremities, accumulate abdominal fat, or both
-also observed are breast enlargement, fat accumulat