CSR certified specialist in renal nutrition Exam with Complete Solutions Nephrotic Syndrome? Caused by? Leads to? ✔️✔️Glomerular damage (from lupus, autoimmune dx, DM, toxins, collagen vascular dx) Leads to proteinuria Proteinuria g/day, s/s ✔️✔️(>3g/day SHOULD BE less than 150mg) fatigued ineffective healing lose muscle mass 3rd spacing (ascites, edema) Nephrotic Syndrome Tx: sodium, fluid, protein, calories, Deficiency repletion ✔️✔️*Sodium: 2g restriction *Fluid restriction ONLY if RF *Protein: DONT PUT ON HIGH PROTEIN -only 24hr urine collection loss+RDA ( 0.7 -0.8 g protein/kg) *Calories for healing *Replete Vit D, Ca, bicarb, iron deficiencies Protein requirement g/kg RDA ✔️✔️0.8 g/kg Protein requirement g/kg CKD (stages 3 -5) ✔️✔️Non-DM 0.55 -0.6 g/kg DM 0.6 -0.8 g/kg Protein requirement g/kg CKD (stage 5D: HD/PD) ✔️✔️Non-DM or DM 1.0 -1.2 g/kg CKD (all stages & dialysis) Energy Kcal/kg ✔️✔️25-35 Kcal/kg Phosphorus mg/day CKD (all stages) ✔️✔️-Adjust dietary Phos intake to maintain serum P levels -Consider bioavailability of Phos sources -Posttransplant or Low Phos, Rx high phos diet and/or suppl Potassium mEq/d CKD (all stages and post transplant) ✔️✔️Maintain normal serum range with diet and suppl prn Sodium mg/day CKD (all stages and post transplant) ✔️✔️*<2300 mg/d for BP and volume control *CKD 3 -5 w/ proteinuria, limit Na+ to <2300mg/d with use of diuretics/etc. Fiber g/day CKD (all stages) ✔️✔️20-30 g/day Fluids ml/day Hemodialysis ✔️✔️750-1500 Unstable patient criteria ✔️✔️-extended or freq hospitalizations -marked deterioration of health status -psychosocial change or poor nutritional status -unmanaged anemia -inadequate dialysis Nutrition Care Process (NCP) advantages ✔️✔️improves consistency & quality of individualized care; provides model & standard language; adoption of core nutrition measures
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