Question

Case Study #10

Mrs. Hendricks is a 65-year-old female who has poor glycemic control with her Type 2 diabetes of 32 years, hypertension, and smokes 1 pack of cigarettes per day. Her most recent glomerular filtration rate is 22 mL/min.

1. What are Mrs. Hendrick’s risk factors for chronic kidney disease (CKD)?

2. Outline appropriate medical nutrition therapy plan of care for Mrs. Hendricks.

Answer 1

1. What are Mrs. Hendrick’s risk factors for chronic kidney disease (CKD)?

Constant kidney illness happens when an infection or condition hinders kidney work, causing kidney harm to exacerbate more than a while or years.

Sicknesses and conditions that reason ceaseless kidney ailment include:

• Type 1 or type 2 diabetes
• Hypertension
• Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis), an aggravation of the kidney's sifting units (glomeruli)
• Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an irritation of the kidney's tubules and encompassing structures
• Polycystic kidney ailment
• Delayed obstacle of the urinary tract, from conditions, for example, augmented prostate, kidney stones and a few diseases
• Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that makes pee back up into your kidneys
• Repetitive kidney contamination, likewise called pyelonephritis (pie-uh-low-nuh-FRY-tis)

Hazard factors

Variables that may expand your danger of incessant kidney sickness include:

• Diabetes
• Hypertension
• Heart and vein (cardiovascular) sickness
• Smoking
• Stoutness
• Being African-American, Native American or Asian-American
• Family ancestry of kidney sickness
• Irregular kidney structure
• More established age

2. Outline appropriate medical nutrition therapy plan of care for Mrs. Hendricks.

What you eat and drink influences your wellbeing. Remaining at a solid weight and eating a fair diet that is low in salt and fat can assist you with controlling your circulatory strain. On the off chance that you have diabetes, you can help control your glucose via cautiously picking what you eat and drink. Controlling hypertension and diabetes may help keep kidney infection from deteriorating.

A kidney-accommodating diet may likewise help shield your kidneys from further harm. A kidney-accommodating diet confines certain nourishments to keep the minerals in those food sources from working up in your body.

With all dinner plans, including the kidney-accommodating eating routine, you have to follow the amount of specific supplements you take in, for example,

•           Calories

•           Protein

•           Fat

•           Carbohydrates

To ensure you are getting the perfect measures of these supplements, you have to eat and drink the correct bit sizes. The entirety of the data you have to monitor your admission is on the "Sustenance Facts" mark.

Utilize the sustenance certainties area on nourishment marks to study what is in the nourishments you eat. The nourishment actualities will disclose to you how much protein, sugars, fat and sodium are in each serving of a nourishment. This can assist you with picking nourishments that are high in the supplements you need and low in the supplements you should restrain.

At the point when you take a gander at the sustenance certainties, there are a couple of key territories that will give you the data you need:

Calories

Your body gets vitality from the calories you eat and drink. Calories originate from the protein, starches and fat in your eating regimen. What number of calories you need relies upon your age, sexual orientation, body size and action level.

You may likewise need to change what number of calories you eat dependent on your weight objectives. A few people should restrain the calories they eat. Others may need to have more calories. Your primary care physician or dietitian can assist you with making sense of what number of calories you ought to have every day. Work with your dietitian to make a dinner arrangement that encourages you get the perfect measure of calories, and stay in contact for help.

Protein

Protein is one of the structure squares of your body. Your body needs protein to develop, mend and remain sound. Having too little protein can cause your skin, hair and nails to be powerless. Be that as it may, having an excessive amount of protein can likewise be an issue. To remain sound and assist you with feeling your best, you may need to modify how a lot of protein you eat.

The measure of protein you ought to have relies upon your body size, movement level and wellbeing concerns. A few specialists prescribe that individuals with kidney infection limit protein or change their wellspring of protein. This is on the grounds that an eating regimen high in protein can make the kidneys work more diligently and may cause more harm. Ask your PCP or dietitian how much protein you ought to have and what the best wellsprings of protein are for you.

Utilize the table underneath to realize which nourishments are low or high in protein. Remember that in light of the fact that a nourishment is low in protein, it isn't beneficial to eat boundless sums.

Lower-protein nourishments:

•           Bread

•           Fruits

•           Vegetables

•           Pasta and rice

Higher-protein nourishments:

•           Red meat

•           Poultry

•           Fish

•           Eggs

Starches

Sugars ("carbs") are the simplest sort of vitality for your body to utilize. Solid wellsprings of sugars incorporate foods grown from the ground. Undesirable wellsprings of starches incorporate sugar, nectar, hard confections, sodas and other sugary drinks.

A few starches are high in potassium and phosphorus, which you may need to confine contingent upon your phase of kidney infection. We'll discuss this in more detail somewhat later. You may likewise need to watch your starches cautiously on the off chance that you have diabetes. Your dietitian can assist you with getting familiar with the starches in your feast plan and how they influence your glucose.

Fat

You need some fat in your feast intend to remain sound. Fat gives you vitality and causes you use a portion of the nutrients in your nourishment. In any case, an excessive amount of fat can prompt weight increase and coronary illness. Attempt to restrain fat in your supper plan, and pick more beneficial fats when you can.

More beneficial fat or "great" fat is called unsaturated fat. Instances of unsaturated fat include:

•           Olive oil

•           Peanut oil

•           Corn oil

Unsaturated fat can help diminish cholesterol. On the off chance that you have to put on weight, attempt to eat increasingly unsaturated fat. In the event that you have to shed pounds, limit the unsaturated fat in your dinner plan. As usual, balance is the key. An excessive amount of "good" fat can likewise cause issues.

Soaked fat, otherwise called "awful" fat, can raise your cholesterol level and raise your hazard for coronary illness. Instances of soaked fats include:

•           Butter

•           Lard

•           Shortening

•           Meats

Point of confinement these in your feast plan. Pick more beneficial, unsaturated fat. Cutting back the excess from meat and expelling the skin from chicken or turkey can likewise help limit immersed fat. You ought to likewise keep away from trans fat. This sort of fat makes your "terrible" (LDL) cholesterol higher and your "great" (HDL) cholesterol lower. At the point when this occurs, you are bound to get coronary illness, which can cause kidney harm.

Sodium

Sodium (salt) is a mineral found in practically all nourishments. A lot of sodium can make you parched, which can prompt growing and raise your circulatory strain. This can harm your kidneys more and make your heart work more enthusiastically.

Probably the best thing that you can do to remain solid is to constrain how a lot of sodium you eat. To restrain sodium in your dinner plan:

•           Do not add salt to your nourishment when cooking or eating. Take a stab at cooking with crisp herbs, lemon juice or other sans salt flavors.

•           Choose new or solidified vegetables rather than canned vegetables. In the event that you do utilize canned vegetables, deplete and wash them to expel additional salt before cooking or eating them.

•           Avoid handled meats like ham, bacon, wiener and lunch meats.

•           Munch on new products of the soil instead of wafers or other salty tidbits.

•           Avoid canned soups and solidified suppers that are high in sodium. • Avoid cured nourishments, similar to olives and pickles. • Limit high-sodium fixings like soy sauce, BBQ sauce and ketchup.

Significant! Be cautious with salt substitutes and "decreased sodium" nourishments. Many salt substitutes are high in potassium. An excess of potassium can be risky in the event that you have kidney ailment. Work with your dietitian to discover nourishments that are low in sodium and potassium.

Segments:

Picking sound nourishments is an extraordinary beginning, yet eating a lot of anything, even solid nourishments, can be an issue. The other piece of a solid eating regimen is partition control, or observing the amount you eat.

To help control your bits:

•           Check the sustenance certainties mark on a nourishment to become familiar with the serving size and the amount of every supplement is in one serving. Numerous bundles have more than one serving. For instance, a 20-ounce container of pop is extremely more than two servings. Numerous crisp nourishments, for example, foods grown from the ground, don't accompany sustenance realities names. Approach your dietitian for a rundown of nourishment actualities for new nourishments and tips for how to quantify the correct segments.

•           Eat gradually, and quit eating when you are not eager any more. It takes around 20 minutes for your stomach to tell your mind that you are full. On the off chance that you eat too rapidly, you may eat more than you need.

•           Avoid eating while at the same time accomplishing something different, for example, sitting in front of the TV or driving. At the point when you are occupied you may not understand the amount you have eaten.

•           Do not eat straightforwardly from the bundle the nourishment came in. Rather, take out one serving of nourishment and set the pack or box away.

Great parcel control is a significant piece of any dinner plan. It is significantly progressively significant in a kidney-accommodating supper plan, since you may need to restrict the amount of specific things you eat and drink.