Clinical evaluation of kidney function

Currently, determination of serum creatinine and blood urea nitrogen (BUN) concentrations, and estimation of glomerular filtration rate (GFR) remain the most important tests to assess the kidney function in clinical practice. GFR can be measured directly by radioisotope methods or indirectly from serum creatinine concentration as estimated GFR (eGFR), using the Modification of Diet in Renal Disease formula. Although serum creatinine concentration of 0.8-1.2 mg dl and a BUN concentration of 10...

Protein Energy Nutritional Status

Assessment of protein-energy nutritional status is one of the most common applications of biochemical assessment. The most commonly used proteins for this purpose are serum albumin, prealbumin, and transferrin. Other biochemical parameters are useful as screening tools serum creatinine, cholesterol, and bicarbonate. Serum proteins can be broadly divided into two categories, negative and positive acute phase proteins. Circulating levels of negative acute phase proteins, such as serum albumin and...

Nephritic Syndrome

The nephritic syndrome, also called glomerulonephritis, is characterized by hematuria, RBC casts, hypertension, renal insufficiency, and varying degrees of proteinuria. Based upon the etiology and pathogenic mechanisms, this syndrome can present as (i) asymptomatic hematuria or proteinuria (ii) acute nephritis to rapidly progressive glomerulonephritis (RPGN) and finally (iii) chronic sclerosing glomerulonephritis. There are several primary (e.g., RPGN) and secondary (e.g., systemic lupus...

Chronic Kidney Disease Chronic Renal Failure

CKD is defined as a gradual decrease in renal function over a period of several months to years. Diabetes, hypertension, glomerulonephritis, cystic kidney diseases, and tubulointerstitial diseases (TIDs) are the major causes of CKD. Approximately 6.2 million people are estimated to have a serum creatinine level of > 1.5 mg dl. Unlike in AKI, serum creatinine level does not represent the extent of renal disease in subjects with CKD. Therefore, either actual determination of GFR by radioisotope...

Nutritional Adequacy and Management Protein Intake

The adequacy of protein intake can be estimated in several ways in people with CKD. Diet records or recalls can provide clinicians detailed information about food choices and can be very useful as educational tools but require a substantial effort from the patient, and thus, can be incomplete records of protein intake (see Subheading 3). Protein intake can also be estimated in clinically stable patients by determining the protein equivalent of total nitrogen appearance (PNA), also called...

Summary of Biochemical Assessment

Serum protein deficits arise from many etiologies in people with CKD (18,24). Simple malnutrition is caused by insufficient nutrient intake relative to requirements and responds to correction of deficient intake. In contrast, malnutrition or wasting caused by inflammation and secondary effects of other comorbidities results in hypermetabolism and inefficient utilization of nutrients. With this form of malnutrition, simple nutritional repletion without measures to correct the underlying...

Learning objectives

To discuss the changing demographics of patients diagnosed with chronic kidney disease. 2. To describe the role of evidence-based guidelines in the management of said patients. 3. To outline future directions in the pursuit of quality care in chronic kidney disease. Since its emergence as a medical specialty in the 1960s, the focus of nephrology has changed dramatically in the past decade. What started as a discipline to provide dialysis and transplant care to patients with kidney failure in...

Biochemical assessment of nutritional status

Biochemical assessment offers the advantages of being readily available in most clinical settings, it is objective, and it requires only minimal patient cooperation. CKD and dialysis procedures each can influence nutritional status, limiting nutrient intake due to anorexia, dietary restrictions, socioeconomic constraints, or impaired gastrointestinal GI motility. In addition, CKD also exerts an indirect effect on nutritional status by increasing requirements and impairing the body's ability to...

Dietary Assessment Tools

Table 5 presents some of the common methods to assess dietary intake and the advantages and disadvantages of each. There are three major types of dietary assessment tools that are useful in CKD. First, there are tools that help the clinician assess intakes of specific nutrients and energy. Examples include 24-h recalls and food records. Next are tools that help one to assess dietary patterns that may vary greatly from day to day e.g. between sick and well days, or between dialysis and...

Physical Examination Techniques

Pellagra Scalp

Classic physical assessment involves inspection, palpation, percussion, and auscultation, generally performed in that order 174 . Vitamin mineral imbalance in dialysis patients affects tissue integrity of the mouth, skin, scalp, eyes, hair, hair follicles, and nails. Inspection and light palpation are techniques used most frequently. While presentation of vitamin and mineral lesions can be discrete, they are generally bilateral in the absence of injury. 5.4.1. Examination of the Mouth The lips...

Adrianne Bendich phd facn Series Editor

Handbook of Nutrition and Pregnancy, edited by Carol J. Lammi-Keefe, Sarah C. Couch, and Elliot H. Philipson, 2008 Nutrition and Health in Developing Countries, Second Edition, edited by Richard D. Semba and Martin W. Bloem, 2008 Nutrition and Rheumatic Disease, edited by Laura A. Coleman, 2008 Nutrition in Kidney Disease, edited by Laura D. Byham-Gray, Jerrilynn D. Burrowes, and Glenn M. Chertow, 2008 Handbook of Nutrition and Ophthalmology, edited by Richard D. Semba, 2007 Adipose Tissue and...

Historical dietary treatment of kidney disease

In the mid-1800s, Richard Bright recommended a milk diet for patients with edema and proteinuria 1 . Fishberg in 1930 and Addis in 1948 recommended protein restriction for uremic patients, but neither identified the biological value of the protein 2,3 . Many at this time believed that dietary protein restriction would decrease the workload and stress on the kidneys. In 1948, Kempner proposed a diet consisting of rice, fruit and sugar for the treatment of acute and chronic renal failure, and it...

Vitamin B

Isonicotinyl Hydrazone Pyridoxal

Although V-B6 deficiency was identified following the development of seizures and anemia in infants given purified diets 196 , experimental depletion in adults was achieved using an anti-metabolite, desoxypyridoxine. Vilter et al. 197 described seborrheic dermatitis of the nasolabial folds, eyebrows, angles of the mouth, retroauricular spaces, and scalp as the primary lesion, evolving after 19-21 days of desoxypyridoxine treatment. Dermatitis was followed by...

Zinc

Acrodermatitis Enteropathica Beaus Lines

Prasad et al. 218 first described zinc deficiency as adolescent nutritional dwarfism, documenting the nutrient's role in growth and sexual maturity. While the early syndrome occurred with iron deficit, identification of an autosomal recessive defect causing acrodermatitis enteropathica 219 produced a clear phenotypic presentation of zinc deficiency alone. Skin lesions with predictable distribution around body orifices and extremities predominate, with functional...

Renal Dietitians Dietetic Practice Group

In 1978, the Renal Practice Group RPG of the ADA was formed. This organization deals with the professional concerns of the renal dietitian, including salary surveys, employment, legislation, and patient education. The RPG publishes a quarterly newsletter that features articles on renal nutrition and patient education. The need for a uniform renal diet that could be used across the United States was identified as early as 1978, when the RPG was first formed. The project was not initiated at that...

Placing Physical Findings Within the Clinical Context of the Patient

Lesions and functional deficits must be placed within the clinical context of the patient. Their presence fits within a time frame, consistent with the patient's nutritional history, disease state, and laboratory findings. These data enable construction of a nutrient-focused hypothesis, explaining why a particular nutrient imbalance would occur in a particular patient, at a particular time. Findings are shared with the interdisciplinary team, and the RD develops the nutrient intake plan with...

References

Original papers of Richard Bright on renal disease. New York Oxford University Press, 1937. 2. Fishberg AM. Hypertension and Nephritis. Philadelphia Lea amp Fabiger, 1939. 3. Addis T. Glomerular Nephritis Diagnosis and Treatment. New York Macmillan Co, 1948. 4. Kempner W. Treatment of hypertensive vascular disease with rice diet. Am J Med 1948 4 545-577. 5. Borst JGG. Protein katabolism in uraemia Effects of protein-free diet, infections and blood transfusions. Lancet 1948 i...