NUTRITION IN DISORDERS OF KIDNEY

FUNCTION
dr.Dimyati Burhanuddin. Msc
Functioning Unit :
Nephron;consist of:
1. Glomeroulus

2. Tubulus

3. Collecting tubulus

Capillaries surrounded by
Bowmans capsules
proximal convolution
loop of henle
distal convolution

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 Na, Cl, 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,
Aldosteron 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

- less 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

-Haemorrhagic neptritis

uremia

-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
hipertensi

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

Renal failure

Chronic pyclonephritis

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 - no urine (<100 ml/day)
Dietary management
-

Controle protein
Sodium
Potassium

Energy : - sufficient calories

Protein: - restrict (18-20 gr/day)
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