Nutrition and Diet Therapy – Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session # 22

LESSON TITLE: Protein-, Mineral-, and Fluid Modified Materials:

Diets for Kidney Diseases Pen and notebook

LEARNING OUTCOMES:

At the end of the lesson, you can:

1. Identify the potential causes and consequences of the
nephrotic syndrome and describe the medical and
nutrition therapies used in treatment;
2. Discuss the potential causes and effects of acute kidney
injury and the approaches to treatment for this
condition; Reference:
3. Describe the potential causes and consequences of DeBruyne, L.K., Pinna, K., & Whitney E., (2016).
chronic kidney disease, its medical treatment, and Nutrition and diet therapy: Principles and practice
nutrition therapy for this condition; (9th ed.). USA: Cengage Learning.
4. Compare the different types of kidney stones; and,
5. Explain how kidney stones can be prevented or treated.

LESSON PREVIEW/REVIEW
Let us have a review of what you have learned from the previous lesson. Kindly answer the following questions on the
space provided. You may use the back page of this sheet, if necessary. Have fun!

Instruction: Define DASH diet and explain its importance.

Dietary Approaches to Stop Hypertension (DASH) is an acronym for Dietary Approaches to Stop Hypertension. The DASH diet is a nutritious eating plan that can
help you manage or avoid high blood pressure (hypertension). Foods’s high in potassium, calcium, and magnesium are included in the DASH diet. These nutrients
aid with blood pressure management.

MAIN LESSON
You will study and read their book, if available, about this lesson.

The two kidneys sit just above the waist on each side of the spinal column. As part of the urinary system, they are
responsible for filtering the blood and removing excess fluid and wastes for elimination in urine. Kidney’s functional units
are the nephrons. Within each nephron, the glomerulus, a ball-shaped tuft of capillaries, serves as a gateway through
which blood components must pass to form filtrate. The glomerulus and surrounding Bowman’s capsule function like a
sieve, retaining blood cells and most plasma proteins in the blood while allowing fluid and small solutes to enter the
nephron’s system of tubules. As the filtrate moves through the tubules, its composition continuously changes as some of
its components are reabsorbed and returned to the blood via capillaries surrounding the tubules; the remaining
substances contribute to the final urine product. By filtering blood and forming urine, the kidneys regulate the extracellular
fluid volume and osmolarity, electrolyte concentrations, and acid base balance.

They also excrete metabolic waste products such as urea and creatinine, as well as various drugs and toxicants. Other
roles of the kidneys include the following:
⎯ Secretion of the enzyme renin, which helps to regulate blood pressure.
⎯ Production of the hormone erythropoietin, which stimulates the production of red blood cells in the bone marrow
⎯ Conversion of vitamin D to its active form, thereby helping to regulate calcium balance and bone formation

This document and the information thereon is the property of

PHINMA Education (Department of Nursing) 1 of 10
This document and the information thereon is the property of
PHINMA Education (Department of Nursing) 2 of 10
A. Nephrotic Syndrome

The nephrotic syndrome is not a specific disease; rather, the term refers to a syndrome caused by significant urinary
protein losses (proteinuria) that result from severe glomerular damage. The condition arises because damage to the
glomeruli increases their permeability to plasma proteins, allowing the proteins to escape into the urine. The loss of these
proteins may cause serious consequences, including edema, blood lipid abnormalities, blood coagulation disorders, and
infections. In some cases, the nephrotic syndrome can progress to renal failure

Causes of the nephrotic syndrome include glomerular disorders, diabetic nephropathy, immunological and hereditary
diseases, infections (involving the kidneys or elsewhere in the body), chemical damage (from medications or illicit drugs),
and some cancers. Depending on the underlying condition, some patients may experience one or more relapses and
require additional treatment to prevent proteinuria from recurring.

Consequences of the Nephrotic Syndrome

Treatment of the Nephrotic Syndrome

Medical treatment of the nephrotic syndrome requires diagnosis and management of the underlying disorder responsible
for the proteinuria. Complications are managed with medications and nutrition therapy. The drugs prescribed may include
diuretics, ACE inhibitors (which reduce protein losses), lipid-lowering drugs, anti-inflammatory drugs (usually
corticosteroids), and immunosuppressants (such as cyclosporine).3 Nutrition therapy can help to prevent PEM, correct
lipid abnormalities, and alleviate edema.

Protein and Energy Meeting protein and energy needs helps to minimize losses of muscle tissue. High-protein diets are
not advised, however, because they can exacerbate urinary protein losses and result in further damage to the kidneys.
Instead, the protein intake should fall between 0.8 and 1.0 gram per kilogram of body weight per day; at least half of the
protein consumed should be from high-quality protein sources. An adequate energy intake (about 35 kcalories per
kilogram of body weight daily) sustains weight and spares protein. Weight loss or infections suggest the need for
additional energy.

Lipids As explained a diet low in saturated fat, trans fats, cholesterol, and refined sugars may help to control elevated
LDL and VLDL levels. Dietary measures are usually inadequate for controlling blood lipids, however, so physicians may
prescribe lipid-lowering medications as well. In some cases, treating the underlying cause of nephrotic syndrome is
sufficient for correcting the lipid disorders.

Sodium and Potassium Controlling sodium intake helps to control edema; therefore, the sodium intake is often limited to
1 to 2 grams daily. Table 23-1 provides guidelines for following a diet restricted to 2 grams of sodium. If diuretics
prescribed for the edema cause potassium losses, patients are encouraged to select foods rich in potassium.

Vitamins and Minerals Multivitamin/mineral supplementation can help patients avoid nutrient deficiencies; nutrients at
risk include iron and vitamin D. To reduce risk of bone loss, calcium supplementation (1000 to 1500 milligrams per day)
may also be advised

B. Acute Kidney Injury

In acute kidney injury, kidney function deteriorates rapidly, over hours or days. The loss of kidney function reduces urine
output and allows nitrogenous wastes to build up in the blood. The degree of renal dysfunction varies from mild to severe.
With prompt treatment, acute kidney injury is often reversible, although mortality rates are high, ranging from 40 to 70
percent in severe cases. Most cases develop in the hospital, occurring in 5 to 7 percent of hospitalized patients.

Causes of Acute Kidney Injury

Consequences of Acute Kidney Injury

A decline in renal function alters the composition of blood and urine. The kidneys become unable to regulate the levels of
electrolytes, acid, and nitrogenous wastes in blood. Urine may be diminished in quantity (oliguria) or absent (anuria),
leading to fluid retention. Acute kidney injury is often identified by reduced urinary output coupled with a progressive rise
in serum creatinine levels. Other laboratory findings may include abnormal levels of serum electrolytes, elevated blood
urea nitrogen (BUN), and various changes in urine chemistry. Diagnosis is sometimes difficult, however, because the
clinical effects can be subtle and vary according to the underlying cause of disease.

Treatment of Acute Kidney Injury

Treatment of acute kidney injury involves a combination of drug therapy, dialysis and nutrition therapy to restore fluid and
electrolyte balances and minimize blood concentrations of toxic waste products. Both medical care and dietary measures
are highly individualized to suit each patient’s needs. Correcting the underlying illness is necessary to prevent further
damage to the kidneys.

In oliguric patients (those with reduced urine production), recovery from kidney injury sometimes begins with a period of
diuresis, in which large amounts of fluid (up to 3 liters daily) are excreted.11 Because tubular function is minimal at this
stage, electrolytes may not be sufficiently reabsorbed; consequently, both fluid and electrolyte replacement may be
necessary in these cases.

Energy and Protein Acute kidney injury is often associated with other critical illnesses, so patients may be
hypermetabolic, catabolic, and at high risk of wasting. Furthermore, patients with acute kidney injury frequently develop
hyperglycemia and hypertriglyceridemia because they are unable to metabolize energy nutrients efficiently. For these
reasons, patients must ingest sufficient protein and energy to preserve muscle mass but should not be overfed. Protein
recommendations are influenced by kidney function, the degree of catabolism, and the use of dialysis (dialysis removes
nitrogenous wastes

Although guidelines vary, patients are usually provided with 20 to 35 kcalories per kilogram of body weight per day, while
body weight, nitrogen balance, blood glucose levels, and blood triglycerides are monitored to ensure that the energy
intake is appropriate.] For non-catabolic patients who do not require dialysis, protein intakes should be limited to 0.8 to 1.0
grams per kilogram body weight per day. Higher intakes (1.0 to 1.7 grams per kilogram daily) may be recommended if
kidney function improves, the patient is catabolic, or the treatment includes dialysis. Patients who require higher amounts
of protein (such as those with burns or large wounds) require more frequent dialysis to accommodate the nitrogen load.

Fluids Health practitioners can assess fluid status by monitoring weight fluctuations, blood pressure, pulse rates, and the
appearance of the skin and mucous membranes. Another method is to measure serum sodium concentrations: a low
sodium level often indicates excessive fluid intake, whereas a high sodium level suggests inadequate fluid intake.

Fluid balance must be restored in patients who are either over hydrated or dehydrated. Thereafter, fluid needs can be
estimated by measuring urine output and adding 400 to 500 milliliters to account for the water lost from skin, lungs, and
perspiration. An individual with fever, vomiting, or diarrhea requires additional fluid. Patients undergoing dialysis can
ingest fluids more freely.

Electrolytes Serum electrolyte levels are monitored closely to determine appropriate electrolyte intakes. Depending on
the results of laboratory tests and the clinical assessment, restrictions may be necessary for potassium (2000 to 3000
milligrams per day), phosphorus (8 to 15 milligrams per kilogram body weight per day), and sodium (2000 to 3000
milligrams per day). Patients undergoing dialysis may be allowed more liberal intakes.

Enteral and Parenteral Nutrition. Many patients need nutrition support to obtain adequate energy and nutrients. Enteral
support (tube feeding) is preferred over parenteral nutrition because it is less likely to cause infection and sepsis. Enteral
formulas for patients with acute kidney injury are more kcalorically dense and may have lower protein and electrolyte
concentrations than standard formulas. Total parenteral nutrition is necessary only if patients are severely malnourished
or cannot consume food or tolerate tube feedings for an extended period.

C. Chronic Kidney Disease

Unlike acute kidney injury, in which kidney function declines suddenly and rapidly, chronic kidney disease is characterized
by gradual, irreversible deterioration. Because the kidneys have a large functional reserve—they are able to increase their
workload to meet demands—chronic kidney disease typically progresses over many years without causing symptoms.
Patients are often diagnosed late in the course of illness after most kidney function has been lost

The most common causes of chronic kidney disease are diabetes mellitus and hypertension, which are estimated to
cause 45 and 27 percent of cases, respectively. Other conditions that lead to chronic kidney disease include
inflammatory, immunological, and hereditary diseases that directly involve the kidneys.

Consequences of Chronic Kidney Disease

In early stages of chronic kidney disease, the nephrons compensate by enlarging so that they can handle the extra
workload. As the nephrons deteriorate, however, there is additional work for the remaining nephrons. The overburdened
nephrons continue to degenerate until finally the kidneys are unable to function adequately, resulting in kidney failure.
Once the extent of kidney damage necessitates active treatment— either dialysis or a kidney transplant—the condition is
classified as end-stage renal disease

Chronic kidney disease is evaluated based on the glomerular filtration rate (GFR), the rate at which the kidneys form
filtrate, and the degree of albuminuria, the amount of albumin lost in urine daily. GFR is considered the best index of
overall kidney function, whereas albuminuria reflects the extent of kidney damage and correlates well with disease
progression and health risks.

Evaluation of Chronic Kidney Disease

A complete assessment of chronic kidney disease takes into account the likelihood of health risk, as indicated by the
degree of albuminuria and other markers of kidney damage. Glomerular filtration rate, or GFR, is usually estimated
using the Modification of Diet in Renal Disease study equation, which is based on serum creatinine levels,

Altered Electrolytes and Hormones. As the GFR falls, the increased activity of the remaining nephrons is often sufficient
to maintain electrolyte excretion. Thus, fluid and electrolyte disturbances may not develop until the third or fourth stage of
chronic kidney disease. A number of hormonal adaptations also help to regulate electrolyte levels, but these changes may
cause complications of their own.

The increased secretion of aldosterone helps to prevent increases in serum potassium but contributes to fluid overload
and the development of hypertension aldosterone (in patients who were not previously hypertensive). Increased
secretion of parathyroid hormone helps to prevent elevations in serum phosphate but contributes to bone loss and the
development of renal osteodystrophy, a bone disorder common in renal patients. Electrolyte imbalances are likely when
the GFR is very low (below 5 milliliters per minute), when hormonal adaptations are inadequate, or when intakes of water
or electrolytes are either very restricted or excessive.

Uremic Syndrome Uremia may develop during the final stages of chronic kidney disease, when the GFR falls below about
15 milliliters per minute.20 As mentioned previously, the many complications that result from uremia are collectively
known as the uremic syndrome. Clinical effects may include the following:
⎯ Hormonal imbalances. Diseased kidneys are unable to produce erythropoietin, causing anemia. Reduced
production of active vitamin D contributes to bone disease.
⎯ Altered heart function/increased heart disease risk. Fluid and electrolyte imbalances result in hypertension,
arrhythmias, and eventual heart muscle enlargement. Excessive parathyroid hormone secretion leads to
calcification of arteries and heart tissue.
⎯ Neuromuscular disturbances. Initial symptoms may be mild, and include malaise, irritability, and altered thought
processes. Later effects include muscle cramping, restless leg syndrome, sensory deficits, tremor, and seizures.
⎯ Other effects. Defects in platelet function and clotting factors prolong bleeding time and contribute to bruising, GI
bleeding, and anemia. Skin changes include increased pigmentation and severe pruritus (itchiness). Many
patients have reduced immune responses.

Protein-Energy Malnutrition. Patients with chronic kidney disease often eat poorly and develop PEM and wasting.
Anorexia is common and may be caused by hormonal disturbances, restrictive diets, uremia, depression, or the effects of
other illnesses.

Treatment of Chronic Kidney Disease

Drug Therapy. Medications help to control some of the complications associated with chronic kidney disease. Treatment
of hypertension is critical for preventing disease progression and reducing cardiovascular disease risk; thus,
antihypertensive drugs are often prescribed. Some antihypertensive drugs (such as ACE inhibitors) can reduce
proteinuria, helping to prevent additional kidney damage. Anemia is usually treated by injection or intravenous
administration of erythropoietin (epoetin). Other drug treatments may include phosphate binders (taken with food) to
reduce serum phosphate levels, sodium bicarbonate to reverse acidosis, and cholesterol-lowering medications.

Dialysis. Dialysis replaces kidney function by removing excess fluid and wastes from the blood. In hemodialysis, the
blood is circulated through a dialyzer (artificial kidney), where it is bathed by a dialysate, a solution that selectively
removes fluid and wastes. In peritoneal dialysis, the dialysate is infused into a person’s peritoneal cavity and blood is
filtered by the peritoneum (the membrane surrounding the abdominal cavity). After several hours, the dialysate is drained,
removing unneeded fluid and wastes.

Nutrition Therapy for Chronic Kidney Disease. The patient’s diet strongly influences disease progression and the
development of complications. Because the dietary measures for chronic kidney disease are complex and nutrient needs
change frequently during the course of illness, a dietitian who specializes in renal disease is best suited to provide
nutrition therapy.

Energy. Patients with chronic kidney disease should consume an energy intake that allows them to maintain a healthy
body weight. Because obesity has been associated with disease progression, obese patients may benefit from weight
loss. Individuals at risk of PEM and wasting should consume foods with high energy density; some malnourished patients
may require oral supplements or tube feedings to maintain an appropriate weight. Wasting is more prevalent during
maintenance dialysis than in earlier stages of illness.
From the blood to the peritoneal cavity by osmosis; 40 to 60 percent of this glucose is absorbed. The kcalories from
glucose (as many as 800 kcalories daily) must be included in estimates of energy intake. Weight gain is sometimes a
problem when peritoneal dialysis continues for a long period.

Protein. A moderate protein restriction may be prescribed to slow disease progression and reduce nitrogenous wastes.
Furthermore, low-protein diets supply. less phosphorus than high-protein diets, reducing the risk of hyperphosphatemia.
Because renal patients often develop PEM, however, their diet must provide enough protein to meet needs and prevent
wasting. During the later stages of kidney disease, the recommended protein intake is 0.6 to 0.75 grams per kilogram of
body weight per day, slightly below the protein RDA for adults (0.8 grams per kilogram).

Lipids. To control elevated blood lipids and reduce heart disease risk, patients with chronic kidney disease may be
advised to restrict intakes of saturated fat, trans fats, and cholesterol. Although patients are often encouraged to consume
high-fat foods to improve their energy intakes, the foods they select should provide mostly unsaturated fats. Good choices
include nuts and seeds, oil-based salad dressings, mayonnaise, avocados, and soybean products.

Sodium and Fluids As kidney disease progresses, patients excrete less urine and become unable to handle normal
amounts of sodium and fluids. Recommendations depend on the total urine output, changes in body weight and blood
pressure, and serum sodium levels. A rise in body weight and blood pressure suggests that the person is retaining
sodium and fluid; conversely, declines in these measurements indicate fluid loss. Most persons with kidney disease tend
to retain sodium and may benefit from mild restriction; less often, a patient may have a salt-wasting condition that requires
additional dietary sodium.

Fluids are not restricted until urine output decreases. For a person who is neither dehydrated or overhydrated, the daily
fluid intake should match the daily urine output. Once a person is on dialysis, sodium and fluid intakes should be
controlled so that only about 2 pounds of water weight are gained daily—this excess fluid is then removed during the next
dialysis treatment. Patients on fluid-restricted diets should be advised that foods such as flavored gelatin, soups, fruit ices,
and frozen fruit juice bars contribute to the fluid allowance.

Potassium. Most patients can handle typical intakes of potassium during stages 1 through 4 of illness. Restrictions are
generally advised for patients who develop hyperkalemia, have diabetic nephropathy (which increases risk of
hyperkalemia), or reach a later stage of illness. Conversely, potassium supplementation may be necessary for persons
using potassium-wasting diuretics.

Dialysis patients must control potassium intakes to prevent hyperkalemia or, more rarely, hypokalemia. Restriction is
necessary for persons treated with hemodialysis, whereas those undergoing peritoneal dialysis can consume potassium
more freely. Recommended intakes are based on serum potassium levels, renal function, medications, and the dialysis
procedure used.
Calcium, Phosphorus, and Vitamin D To minimize the risk of bone disease, serum phosphate and calcium levels are
monitored in renal patients and laboratory values help to guide recommendations. Elevated serum phosphate levels
indicate the need for dietary phosphorus restriction and, if necessary, the use of phosphate binders (taken with meals)

Vitamins and Minerals The restrictive renal diet interferes with vitamin and mineral intakes, increasing the risk of
deficiencies. In addition, patients treated with dialysis lose water-soluble vitamins and some trace minerals into the
dialysate. Thus, multivitamin/ mineral supplements are typically recommended for all patients

Enteral and Parenteral Nutrition. Nutrition support is sometimes necessary for renal patients who cannot consume
adequate amounts of food. The enteral formulas suitable for chronic kidney disease are more kcalorically dense and have
lower protein and electrolyte concentrations than standard formulas. Intradialytic parenteral nutrition is an option for
supplying supplemental nutrients to dialysis patients; this technique combines parenteral infusions with hemodialysis
treatments.

Dietary Compliance. Adhering to a renal diet is probably the most challenging aspect of treatment for renal disease
patients. Depending on the stage of illness and the patient’s laboratory values, the renal diet may limit protein, fluids,
sodium, potassium, and phosphorus, thereby affecting food selections from all major food groups. In addition,
adjustments in nutrient intake are required as the disease progresses. If the kidney disease was caused by diabetes,
patients must also continue the dietary changes necessary for controlling blood glucose levels. Because renal diets have
so many restrictions, patient compliance is often a problem.

Kidney Transplants. A preferred alternative to dialysis in patients with end-stage renal disease is kidney transplantation.
A successful kidney transplant restores kidney function, allows a more liberal diet, and frees the patient from routine
dialysis. Given the choice, many patients would prefer transplants, but the demand for suitable kidneys far exceeds the
supply. Other barriers to transplantation include advanced age, poor health, and financial difficulties. Approximately 30
percent of patients with end-stage renal disease receive a kidney transplant.

Nutrition Therapy after a Kidney Transplant. After patients recover from transplant surgery, most nutrients can be
consumed at levels recommended for the general population. Patients should attempt to maintain a healthy body weight
and consume a diet that reduces their risk for cardiovascular diseases. For most transplant patients, the side effects of
drugs are the primary reason that dietary adjustments may be required. Although sodium, potassium, phosphorus, and
fluid intakes are usually liberalized following a transplant, serum electrolyte levels must be monitored because some drug
therapies can cause electrolyte imbalances or fluid retention.

D. Kidney Stones

A kidney stone is a crystalline mass that forms within the urinary tract. Although stones are often asymptomatic, their
passage can cause severe pain or block the urinary tract. Stones tend to recur but can be prevented with dietary
measures and medical treatment

Formation of Kidney Stones

Calcium Oxalate Stones. The most common abnormality in people with calcium oxalate stones is hypercalciuria
(elevated urinary calcium levels). Hypercalciuria can result from excessive calcium absorption, impaired calcium
reabsorption in kidney tubules, or elevated serum levels of parathyroid hormone or vitamin D. However, some people with
calcium oxalate stones excrete normal amounts of calcium in the urine, and the reason they form stones is unknown.

Elevated urinary oxalate levels, or hyperoxaluria, also promote the formation of calcium oxalate crystals. Oxalate is a
normal product of metabolism that readily binds to calcium. Hyperoxaluria reflects an increase in the body’s synthesis of
oxalate or increased absorption from dietary sources. Fat malabsorption can increase oxalate absorption: the
malabsorbed fatty acids bind to minerals (such as calcium and magnesium) that would otherwise bind to oxalates and
inhibit their absorption
Uric Acid Stones Uric acid stones develop when the urine is abnormally acidic, contains excessive uric acid, or both.
These stones are frequently associated with gout, a metabolic disorder characterized by elevated uric acid levels in the
blood and urine. A diet rich in purines also contributes to high uric acid levels; purines are abundant in animal proteins
(meat, poultry, seafood) and degrade to uric acid in the body. In addition, a high intake of animal protein increases urine
acidity, which promotes the crystallization of uric acid.
Cystine and Struvite Stones Cystine stones can form in people with the inherited disorder cystinuria, in which the renal
tubules are unable to reabsorb the amino acid cystine. This abnormality results in high concentrations of cystine in the
urine, leading to subsequent crystallization and stone formation. Struvite stones, composed primarily of magnesium
ammonium phosphate, form in alkaline urine; the urinary pH is sometimes elevated due to the bacterial degradation of
urea to ammonia. Struvite stones can accompany chronic urinary infections or disorders that interfere with urinary flow.

Consequences of Kidney Stones

In most cases, kidney stones do not pose serious medical problems. Small stones can readily pass through the ureters
and out of the body with minimal treatment.
⎯ Renal Colic A stone passing through the ureter can produce severe, stabbing pain, called renal colic. Generally, the
pain begins in the back and intensifies as the stone travels toward the bladder. The pain can be severe enough to
cause nausea and vomiting and sometimes requires medication. Blood may appear in the urine (hematuria) as a
result of damage to the kidney or ureter lining.
⎯ Tract Complications Depending on the location of the stone, symptoms may include urination urgency, frequent
urination, or inability to urinate. Stones that are unable to pass through the ureter can cause a urinary tract obstruction
and possibly lead to infection or acute kidney injury

Prevention and Treatment of Kidney Stones

Solutes are less likely to crystallize and form stones in dilute urine. Therefore, people who form kidney stones are advised
to drink 12 to 16 cups of fluid daily to produce more than 2 to 2½ liters of urine per day. Additional fluid may be needed in
hot weather or if an individual is extremely active.

Calcium Oxalate Stones Most dietary strategies and drug treatments for calcium oxalate stones aim to reduce urinary
calcium and oxalate levels. Dietary measures may include adjustments in calcium, oxalate, protein, and sodium
intakes.35 Patients should consume adequate calcium from food sources (about 800 to 1200 milligrams per day) because
dietary calcium combines with oxalate in the intestines, reducing oxalate absorption and helping to control hyperoxaluria.*

Uric Acid Stones Although diets restricted in purines may help to control urinary uric acid levels, the effects on stone
formation are unclear. Moreover, because all animal proteins contain purines, long-term restriction can be difficult to
achieve. Drug treatments for uric acid stones include allopurinol to reduce uric acid levels and potassium citrate to reduce
urine acidity

Cystine and Struvite Stones High fluid intakes may prevent the formation of cystine stones in some patients, whereas
other individuals require drug therapy to reduce cystine production in the body. Medications frequently prescribed include
penicillamine (Cuprimine) and tiopronin (Thiola), which increase the solubility of cystine, and potassium citrate, which
reduces urine acidity. For preventing struvite stones, preventing or promptly treating urinary tract infections is a central
strategy

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the
correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not
allowed.

1. Which of the following is not a function of the kidneys?

a. Activation of vitamin K
b. Maintenance of acid-base balance
c. Elimination of metabolic waste products
d. Maintenance of fluid and electrolyte balances
ANSWER: A
RATIO: Activation of vitamin K is not a function of the kidneys

2. The nephrotic syndrome frequently results in:

a. the uremic syndrome.
b. oliguria.
c. edema.
d. renal colic.
ANSWER: C
RATIO: The nephrotic syndrome frequently results in edema

3. If a patient with acute kidney injury should require a high protein intake, which additional treatment may be necessary?
a. Frequent dialysis
b. Use of diuretics
c. Enteral nutrition support
d. Fluid restrictions
ANSWER: A
RATIO: If a patient with acute kidney injury should require a high protein intake Frequent dialysis is necessary

4. The most common cause of chronic kidney disease is:

a. diabetes mellitus.
b. hypertension.
c. autoimmune disease.
d. exposure to toxins.
ANSWER: A
RATIO: The most common cause of chronic kidney disease is diabetes mellitus.

5. A person with chronic kidney disease who has been following a renal diet for several years begins hemodialysis
treatment. An appropriate dietary adjustment would be to:
a. reduce protein intake.
b. consume protein more liberally.
c. increase intakes of sodium and water.
d. consume potassium and phosphorus more liberally
ANSWER: C
RATIO: An appropriate dietary adjustment would be to consume protein more liberally.

RATIONALIZATION ACTIVITY
The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER:
RATIO:

2. ANSWER:
RATIO:

3. ANSWER:
RATIO:
4. ANSWER:
RATIO:

5. ANSWER:
RATIO:

LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: MUDDIEST POINT

This technique will help you determine which key points were missed in the main lesson. You will respond to only one
question:

In today’s session, what was least clear to you?

NONE