Question

Mrs. Kouassi is a 44-year-old African from the lvory Coast. Although she was diagnosed with hypertension about eleven years ago, it was left untreated. A year ago, she was seen in the Emergency Department for fatigue, poor appetite, nausea, and vomiting. She complained of shortness of breath, muscle weakness, and swelling of her lower legs. Her blood pressure reached 220/210. She was hospitalized, diagnosed with end-stage renal disease (ESRD), and started on hemodialysis. She currently goes to a dialysis center four times a week. She has not been working since she was diagnosed, and is receiving disability. Currently, her parathyroid hormone is elevated Mrs. Kouassi is 5 feet 5 inches tall and weighs 145 pounds. When asked about her diet, Mrs. Kouassi states that she tried to follow the prescribed diet, but it is difficult because she likes to eat African foods such as palm oil and butter, rice, yams, soups, tea, and dishes such as fufu (cooked fine-blended cassava). She also likes fruits and vegetables, especially when they are combined with other foods such as in vegetable pizza. 1. What diseases or conditions can lead to chronic kidney disease? What signs and symptoms of chronic kidney disease did Mrs. Kouassi exhibit when originally diagnosed? 2. 3. What dietary recommendations are appropriate for Mrs. Kouassi in terms of energy, protein, fat, fluids, sodium, potassium, calcium, and phosphorus? Refer to Table 22-5 for assistance. 4. How does hemodialysis help to prevent disease progression? 5. Why are protein restrictions relaxed once dialysis begins?

Answer 1

1. conditions or diseases that can lead to chronic kidney disease

many factors that can lead to chronic kidney disease. factors that may increase the risk of chronic kidney disease includes:

• diabetes, it can be both type1 or type 2
• high blood pressure
• heart and blood vessel disease
• glomerulonephritis ( inflammation of the glomeruli
• polycystic kidney disease
• prolonged obstruction of the urinary tract like enlarged prostate, kidney stones and some cancers
• recurrent urinary infection
• vesicoureteral reflux ( backup flow of urine to kidneys)
• smoking
• obesity
• race
• family history of renal disease
• older age

2. signs and symptoms

• hypertension
• fatigue
• poor appetite
• nausea
• vomiting
• shortness of breath
• muscle weakness
• swelling of her lower legs
• elevated levels of parathyroid hormone

3. dietary recommendations for chronic kidney disease

there should be a control over the amount of nutrients that you take, which is very important in case of renal disease. especially , you need to track how much of certain nutrients you take in such as:

• calories- the amount of calorie intake depend on the age, gender, body size and activity level
• protein- it is the building blocks of your body
  • lower protein foods are bread, fruits, vegetables, pasta and rice
  • higher protein foods are red meat, poultry, fish, eggs. avoid high protein foods in case of CKD
• carbohydrates- healthy sources of carbohydrates include fruits and vegetables. unhealthy sources include sugar, honey, hard candies, soft drinks and other sugary drinks.
  • some carbohydrates are high in potassium and phosphorus, which is need to be limit in case of CKD
• fat- unsaturated food is healthy ( eg: olive oil, peanut oil, corn oil) but saturated fat is bad and unhealthy like butter, lard, meats. limit these in your meal plan
• sodium (salt)- this makes thirsty, which can leads to swelling and raise your blood pressure, which worsens your kidney disease. to limit sodium in your diet
  • do not add salt to food. try cooking with fresh herbs, leon juice or other salt- free spices
  • use fresh vegetables instead of canned vegetables
  • avoid processed meats
  • avoid salt substitutes as it may contain high potassium
• limit potassium intake
  • lower potassium foods include apples, cranberries, grapes, pineapples, cauliflower, onions, pepper, lettuce, white breads, beef and chicken, white rice
  • high potassium foods include avocados, bananas, melons, oranges, raisins, plaintains, spinach, potatoes, tomatoes, bran products,beans, brown rice etc
• phosphorous- it works with calcium and vitamin D which helps in bones healthy. reduce the intake of phosphorus containing foods in case of CKD
  • lower phosphorus foods - corn or rice cereals, cream of wheat, unsalted popcorn, some light colored sodas and lemonade
  • higher phosphorus gfoods -whole grain bread, bran cereals, oatmeal, nuts and sunflower seeds, dark colored colas
• fluids- reduce water intake as per dietician instruction as it causes swelling and other problems

4. dialysis will help to improve the energy level. it helps to limit the water level. during hemodialysis it filter the blood. this helps to remove wastes, extra salt and fluid from your body. this maintains the proper level of sodium, potassium and other minerals in the blood which will reduce the risk for disease

5. advanced kidney disease and dialysis cause a higher need for protein intake. protein is an important nutrientthat helps build muscle, repair tissue and fight diseases