Question

Thomas Stone is a 55-year-old banker who developed chronic kidney disease as a result of hypertension. His condition was dis- covered several years ago, when routine laboratory tests revealed function declines? elevated serum creatinine levels and persistent albuminuria. Since then, he has been taking antihypertensive medications and stage of disease, when kidney failure develops. Explain the restricting dietary sodium, but he reported difficulty following the low-protein diet that was also prescribed. Mr. Stone recently 3. Explain why a low-sodium, low-protein diet was prescribed visited his doctor with complaints of low urine output and reduced for Mr. Stone at a former visit. What energy and protein sensation in his hands and feet. He also reported feeling drowsy at work and mentioned that he was bruising more than usual. The 4. The physician determines that Mr. Stone's kidney disease has examination revealed a 9-pound weight gain since his last visit and reached the final stage and prescribes hemodialysis. How wil dl swelling in his ankles and feet. Tests revealed that his GFR had fallen to 10 milliliters per minute. Mr.Stone is 5 feet 8 inches tall and normally weighs 160 pounds. 1. Explain how chronic kidney disease progresses. What hap pens to GFR, serum creatinine levels, and albuminuria as renal 2. Describe the clinical effects you would expect during the fina significance of each of Mr. Stone's physical complaints intakes were probably recommended at that time? ysis alter Mr. Stone's diet? Calculate his new protein recommenda tion, and compare it to the amount of protein recommended befor dialysis. What other changes in nutrient intake may be necessary

Answer 1

1. ANS: Chronic kidney disease is characterized by gradual, irreversible deterioration of kidney function. Chronic kidney disease typically progresses over many years without causing symptoms. Patients are often diagnosed late in the course of illness after most kidney function has bee lost. The GFR (glomerular filtration rate), which is the rate at which the kidneys form filtrate, serum creatinine levels increase, and the degree of albuminuria, which is the amount of albumin lost in urine daily. As the renal function declines, so do the GFR and albuminuria levels.

GFR <15 milliliters per minute = kidney failure.

2. ANS: During the final stage of the disease when kidney failure develops, the patient must go on dialysis or get a kidney transplant. Mr. Stone’s reduced sensation in the hands and feet are neuromuscular disturbances. He also complains of edema, low urine output, drowsiness, and he bruises easier.

3. ANS: A low-protein diet was prescribed for Mr. Stone at a former visit because it can slow disease progression and reduce nitrogenous wastes. Also,low-protein diets supply less phosphorus than high-protein diets, reducing the risk of hyperphosphatemia. The recommended intake of protein is 0.6 to 0.75 g/kg of body weight/day during the later stages of kidney disease. He was prescribed a low-sodium diet because as kidney disease progresses, patients excrete less urine and become unable to handle normal amounts of sodium and fluids. Also most people with kidney disease tend to retain sodium. The recommended amount of sodium would be 2000-3000 during end stage kidney disease.

4. ANS: Protein requirement on dialysis: 1.2-1.4 g/kg body weight (72.7 kg / 1.3 = 55.5 g protein/ day). Protein requirement before dialysis: 0.6- 0.8g/kg body weight (72.7 kg / 0.75 = 97g protein/ day). His fluid will be 500-1000 ml + urine output. His energy intake will remain the same.

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