Paula Hawkins

7/15/2013
Basic Nutrition
Chapter 23
1. For each of the following conditions, outline nutritional components of
therapy, explaining effect of each on kidney function: glomerulonephritis, ARF
(renal insufficiency), and chronic renal failure.
- Glomerulonephritis: A form of nephritis affecting the capillary loops in an
acute short term infection. It may progress to a more serious chronic
condition leading to irreversible renal failure.
- ARF: Linked with major in hospital morbidity and mortality. Immediate and
continuing nutrition support is essential. The major sign of AFT is oliguria,
diminished urine output often accompanied by proteinuria or hematuria. This
diminished urine output is brought out by underlying tissue problems that
characterize ARF. The ARF patient nutrition requirements are directly
influenced by type of renal placement therapy, nutritional and metabolic
status and degree of hypercatabolism.
- Chronic Renal Failure: Irreversible loss of excretory, endocrine, and metabolic
capacities of the kidney occur as a result of kidney damage. Once the disease
progresses to stage 5 kidney failure continuance of life requires initiation of
maintenance dialysis therapy of subsequent kidney transplantation.

2. Identify four clinical conditions that impair renal function. Give an example of
each, describing its effect on various structures in the kidney?
-Renal function may be impaired by a variety of conditions. These include
inflammatory and degenerative diseases, infection and obstruction, chronic
diseases such as hypertension and diabetes, environmental agents such as
insecticides and solvents and other toxic substances and some medications
and trauma.

3. List nutritional factors that must be monitored in individuals undergoing renal

dialysis.
-Nutritional factors that must be monitored in individuals are calories,
proteins, fluid, and electrolyte balance.

4. Outline nutrition therapy used for patients with various types of kidney
stones. Describe each type of stone and explain the rationale for each aspect
of therapy?
-Types of kidney stones are struvite stones, uric acid stones, cysteine stones.
Struvite: Often called infections stones because they are associated with
UTIs. The offending organism in the infection is Proteus mirabilis. This is a
urea splitting bacterium that contains urease, an enzyme that hydrolyzes
urea to ammonia. Thus urinary pH becomes alkaline, in the ammonia rich
environment struvite precipitates and forms large staghorn stones. Surgical
removal is usually indicated.
Uric Acid: Excess uric acid excretion may be caused by impairment in
intermediary metabolism of purine as occurs in gout. Cancer chemotherapy
may also cause urine to be acidic which aids in hyperuricemia.
Cystine: A hereditary metabolic defect in renal tubular reabsorption of the
amino acid cystine causes this substance to accumulate in urine. This
condition is called cystinuria. Because this is a genetic disorder it is
characterized by early onset and a positive family history. This is one of the
most common metabolic disorders associated with kidney stones in children
before puberty.