NUTRITION IN DISORDERS OF KIDNEY FUNCTION

dr.Dimyati Burhanuddin. Msc Functioning Unit : Nephron;consist of: 1. Glomeroulus 2. Tubulus Capillaries surrounded by Bowmans capsules proximal convolution loop of henle distal convolution

3. Collecting tubulus

Blood flours in glomeroulus ; afferent arteriole afferent arteriole peritubular capillaries Function: maintain the constant compositon and volume of the blood Regulation of osmotic pressure Electrolite and water balance Acid base balance

homeostatis interstitial and intracellular Urine composition ; - water - Solution contains NaCl, e.t.c. - Metabolic product ; urea - Toxic substances Filtration; - 1200 ml/mt blood kidney - glomerular filtration; 180l/24 h Tubulus : - reabsorbtion;proximal convoluation loof of henle distal convolution

-glucosa -aminoacid -ascorbic acid -acetoacetic acid -85 % water + alactrolite Na+,K+ CL-, HCO3-,HSO4-,SO4 Distal convulation final controle Level Na+ < in blood plasma, Aldosterm reab Na+ Fermeability of tubular cell in mechanism of reabsorption is under the influence of anti diuretic hormon Reabsorption by - diffusion -active transport Fluid and electrolite balance : Influenced by : Permeability of membrane Hydrostatic pressure Colloid osmotic pressure (large molecule protein) Osmotic effect of electrolite (intra exstra) Lymph flow Active transport Competition of substances Hormonal, nervous controls Fluid imbalance - loss intake -abnormal loss (activity,disease)

Leads to : Decrease peristaltic action Reduced blood volume Poor absorption Impairment of renal function Circulatory failure

Acidosis :

- increase of H+ -loss of base

Alkaliosis :

-in the contrasy

H2CO3 carbonic acid, weak acid HCO3- bicarbonate (strong base)

Ratio :

HCO3H2CO3

20 1 < 20 acidosis (pH <7.35) < 20 alkalosis (pH >7.35)

NEPHRITIS Latent healed Active acute Chronic glomerulonefritis uremia

-Haemorrhagic neptritis -a streptococcal infection -mostly children and young adults

Symptoms :

-ankle swelling -puffiness -headache -amorexia -neusea -vomiting

Clinical finding :

-hypertension -dimness of vision -convulsions

Dietary management : -maintain fluid balance -provide non protein calories -sweet foods

Improves appetite returns ; 1. Energy RDA (recommended dietary allowances) 2. Protein : N retention + restrict / low protein diet Protein uria + , high protein 3. Sodium ; edema restrict Na 4. Fluid ; - oliguria low fluid intake -vomiting,diarrhea high fluid intake

CHRONIC GLOMERULO NEPHRITIS Latent no symptons Progress : - symptom + - clinical finding +

: urine volume > Massive edema Protein uria Nephritic syndrome

Anemia hypoprotemia

renal failure

dietary management Maintain good nutrition Control protein deficiency Prevent edema Palatable and easily digested meals

- Protein 60 70 gr/day - Calorie 2000-3000 cal/day - Na restrict 500 1000 mg /day

RENAL FAILURE Chronic glomerulonephritis Nepro selerosis Chronic pyclonephritis Renal failure

1. Uremia (urine in blood) - Abnormal amount of urea in blood - Impairment of renal function Changes the complex of biochemical urea blood called renal uremia Exstra renal uremia ; the chemical changes occure in exstra renal ; Haemarohage Excessive loss of plasma (burns of injuries) Excussive loss of fluid (septicemia, general anasthetic)

shock renal failure 2. Arthemia - accumulation of nitrogenous constituents in the blood 3. Oliguria - dimmished output of urine (<500 ml/day)

4. Anuria Dietary management

- no urine (<100 ml/day)

Energy : - sufficient calories Protein: - restrict (18-20 gr/day)

Controle protein Sodium Potassium

Pottasium: restrict (1000-2000 mg/day) Sodium : restrict 200 500 mg/day (overhydration) 100 2000 mg/day (hypertension without Na retention) Vitamin : multi vitamin supplement (espec B1, C)

DIALYSIS: 1. Hemodialysis - artetical kidney - the blood circulates out side the body - hypotonic dialising fluid

Removes the N wastes

Blood urea 2. Peritoneal dialysis - 1 2 dialising fluid peritoneal cavity - With drawing the fluid after 30 60 minutes repeat until blood urea