introduction
�More than 114,000 Americans diagnosed with end-stage renal disease each year
�Reduced kidney function often undiagnosed
�Requires extensive medical nutrition therapy
�Dialysis extends lives but carries high costs
�Kidney disease is common, serious and co
Kidney Anatomy, Physiology, and Disease
�Kidney disease interferes with the normal capacity of nephrons to filter waste products of metabolism
�Proximal tubule: reabsorbs needed nutrients and returns them to blood
�Loop of Henle: exchanges sodium, chloride, water
�Distal tubule: secretes hydrog
basic structure of kidney
�Nephron is the basic functional unit
�Glomerulus: cluster of capillaries within the Bowman's capsule filters the blood
� Rate of filtration is the glomerular filtration rate (GFR) and is used to assess kidney function
�Tubules: carry filtered fluid to ki
kidney function
�Removes and filters particles from blood (ammonia, urea, drug metabolites)
�Reabsorbs electrolytes (sodium, chloride, potassium)
�Secretes hydrogen ions to maintain pH levels
�Excretes waste materials into concentrated urine
endocrine function
�Secretes renin and erythropoietin
�Converts inactive vitamin D to active form
general causes of kidney disease
�Infection and obstruction: bladder infections, kidney stone
�Damage from other diseases: diabetes mellitus, hypertension, others less common
�Toxins: environmental agents, animal venom, certain plants, heavy metals, some drugs
�Genetic or congenital defe
disease course
�Length of disease: acute or chronic
�Acute infection usually controlled with antibiotics
�Chronic: more specific nutrient modifications
�Degree of impaired kidney function
�Extensive: extensive nutrition therapy required
acute kidney diseases
�Acute Glomerulonephritis* or Nephritic syndrome -- Inflammation of glomeruli
�Nephrotic Syndrome -- Nephron tissue damage
�Acute Kidney Injury (Kidney failure) -- Inadequate blood flow, damage or obstruction of the kidneys
�Other causes of kidney injury
chronic kidney disease
�Chronic Kidney Disease -- Progressive breakdown of kidney tissue
Causes: Metabolic disease with kidney involvement-- Primary glomerular disease-- Congenital/genetic abnormality (Polycystic kidney disease)--Autoimmune disease (i.e. Lupus, Goodpasture's di
CHRONIC KIDNEY DISEASE:COSTS
CKD= $84 billion
ESKD= $36 billion
25% of the annual Medicaid budget is spent on CKD/ESRD (CDC, 2019)
end-stage renal disease (ESRD)
�Develops from chronic kidney disease
�Irreversible damage to majority of nephrons
�Treatment Options: Long-term dialysis or kidney transplant -- Hemodialysis - 3-4 hour treatments 2-3x/week, -- Peritoneal Dialysis - 4-6 hour daily treatment -- Transplant
chronic kidney disease primary prevention
�Weight loss program
�Exercising 3-4 days a week
�Good glycemic control*
�Keeping blood pressure below 140/90*
�Low-sodium diet
�Adding fresh fruits and vegetables into diet
�Smoking cessation
�Maintaining low cholesterol levels
Avoiding NSAIDs and nephro
CKD secondary prevention
Early identification of pre-symptomatic disease through screening to halt or slow progress
common CKD screening tests-
serum creatinine, BUN, urine protein, urinary albumin
CKD tertiary prevention
�Assess patient's SDOH and access to care
�Maintain a kidney-healthy diet
�Proper blood pressure medication
�Avoiding kidney injury (infection, and nephrotoxic medications such as NSAIDs or aminoglycoside antibiotics, contrast dyes)
�Assemble multidiscipl