Module 1

Kidneys

Key job of the kidneys is to maintain homeostasis: an internal balance of

water and chemicals
They filter the blood
Hormones
o Renin is a kidney blood pressure hormone. It helps control how much
sodium (salt) and fluid the body saves and how relaxed the blood
vessels are. People with kidney disease usually need blood pressure
pills because their kidneys no longer control blood pressure.
o Erythropoietin (EPO) is a kidney hormone that tells the bone marrow to
make new red blood cells. Many people with kidney disease have
anemia, a shortage of red blood cells that makes them feel very tired.
Injections of EPO are used to treat anemia, along with iron.
o Kidneys also make calcitriol, a hormone that helps the body absorb
calcium from food. Without calcitriol, the body steals calcium from the
bones. Over a long period of time, this can cause bone disease.
Calcitriol injections or pills are used to help avoid bone disease in
people with kidney disease.
Diabetes and high blood pressure are two leading causes of kidney disease
ARF: acute renal failure
o Sudden loss of kidney function caused by illness, injury, or toxin that
stresses the kidneys
CKD: chronic kidney disease
o Long and slow process where the kidneys slowly lose function
o 15% or less of function is called ESRD

Stages of CKD
STAGE

DESCRIPTION

GFR*

WHAT TO DO
Diagnose & treat the problem

Kidney damage with

normal or increased GFR

and/or other illnesses to slow the rate

90

Kidney damage with mildly

reduced GFR

60-89

Moderately reduced GFR

30-59

Severely reduced GFR

15-29

Kidney failure

<15

of CKD progression

Reduce heart disease risk

Estimate the rate

of CKDprogression

Assess and treat complications

Prepare for kidney replacement

therapy

Kidney replacement therapy

GFR- glomerular filtration rate

Anemia treatment anemia (a shortage of red blood cells) starts very early in
kidney failure and can make you very tired.
Medication for example, blood pressure pills called ACE inhibitors
orangiotensin receptor blockers (ARBs) can help protect kidney function.
Eating changes some doctors believe a low protein diet can help slow
kidney disease.
Avoiding certain pain pills overuse of some over-the-counter pain pills with
ibuprofen, naproxen, acetaminophen, or pain medications with caffeine in
them can damage kidneys.
Regular blood pressure checks high blood pressure can cause or speed up
kidney failure.
Cut back or quit smoking smoking tobacco can make kidney problems
worse.
ESRD
o Uremia- when both kidneys have stopped working the body fills up with
extra fluid and wastes that would normally be filtered out
o Signs of uremia
Head headaches, fatigue, and fuzzy thinking can be caused by
uremia.

Mouth food may taste bad or like metal, causing a loss of

appetite.
Lungs shortness of breath can be caused by a build-up of fluid
in the lungs or by anemia.
Stomach loss of appetite, nausea, and vomiting can occur if
uremia is very severe.
Bladder less (or no) urine may be produced. Some people still
make urine, but it is mostly fluidthe wastes are not removed.
Hands swelling can be caused by fluid build-up.
Feet swelling can be caused by fluid build-up.
Skin build-up of uremic wastes can cause severe itching.
Blood vessels high blood pressure can occur, because the
failing kidneys no longer keep blood pressure at normal levels.

Module 2

Treatment Options
o Peritoneal dialysis
o Hemodialysis
o Kidney transplant
Dialysis
o Cleans out the blood by taking out wastes and extra fluids
o It keeps in the blood cells and proteins

Peritoneal Dialysis
o
o
o
o
o

CAPD
o
o
o
o
o
CCPD
o
o
o
o
o
o

Peritoneum- membrane that lines the abdominal cavity

This is filled with special fluid called dialysate
After a few hours, the dialysate has all the wastes and fluid it can hold
and is drained out and clean fluid is put in
A catheter is put into the belly
Exchanges happen to drain out the dirty fluid and put in the clean
dialysate
Continuous- all the time
Ambulatory- walking around
Peritoneal
Dialysis- cleaning the blood
People on CAPD do 3-5 exchanges a day
Takes about 30 minutes
This is for people who need more blood than CAPD can give them
Continuous
Cycling
Peritoneal
Dialysis
Uses a machine to do lots of exchanges at night

Hemodialysis

Cleans the blood by using a filter called a dialyzer

Inside the dialyzer are thousands of hallow fibers as thin as hairs with millions
of tiny holes
Blood cells and proteins that are needed are too big to pass through the holes
so they go back to the body and the wastes go through the holes and into the
dialysate fluid
HD is done 3 times a week for 3-4 hours
Home hemodialysis is an option

Transplant

New kidney has to match blood type and tissue

Rejection can occur

Module 9

Heart healthy fats

o Fats that are liquid at room temperature (unsaturated fats)
Protein
o HD causes your body to break down protein faster than usual
o Strive for an albumin level greater than 4 g/dL
Sodium
o Limit to 1200-2000 mg/day
Potassium
o 2000-3000 mg/day
o Lab values should be 6.0 mEq/L
Phosphorus
o Second most common mineral found in the body
o Helps your body use energy and build strong bones and teeth
o When kidneys dont work, extra phosphorus builds up in the body
o Renal bone disease can be a long term problem
Losing calcium from the bones makes them weak
When calcium and phosphorus are out of balance, the
parathyroid glands in your neck make too much parathyroid
hormone
Too much PHT causes even more calcium to be pulled out of the
bones
Normal levels on dialysis
Calcium: 8.4 10 mg/dL
Phosphorus: 3.5 5.5 mg/dL
Calcium-phosphorus product: less than 55
Intact PTH: 150 300 pg/mL
Can take a phosphate binder to help

May need a fluid restriction

Vitamins and Minerals for People on Dialysis

Vitamin or Mineral

How Much
You Need

What It Does for You

Vitamin A

Helps with eyesight, bone and tissue

growth, and immunity to illness

Vitamin B1 (thiamin)

Helps energy production, nerve function,

and carbohydrate use

1.0-5.0 mg/day

Vitamin B2 (riboflavin)

Helps turn nutrients from food into energy

your body can use

1.2-1.7 mg/day

Vitamin B5(pantothenic acid)

Helps energy use, use of food, and

hormones

4.0-7.0 mg/day

Vitamin B6 (pyridoxine,
pyridoxal, pyridoxamine)

Helps protein use, helps the body form red

blood cells, and helps form DNA

10 mg/day

Vitamin B12(colabamin)

Helps maintain healthy nerves and red

blood cells, and helps form DNA

2 mcg/day

Vitamin C (ascorbic acid)

Helps form the structure of bones, cartilage,

muscle, and blood vessels

60 mg/day

Vitamin D (calciferol)

Helps body absorb calcium and phosphorus

Different for
everyone

Vitamin E (tocopherol)

Helps protect cells against damage from

free radicals

Vitamin K (menadione)

Helps blood clot

Biotin

Helps your body use protein, folic acid, and

other vitamins

0.03-0.1
mg/day

Folic acid (folate)

Helps form red blood cells and DNA

0.8-1.0 mg/day

Niacin (nicotinic acid)

Helps the skin, nerves, and digestive

system

13-19 mg/day

Information from the dialysis center that I learned:

Spkt/v: dialysis adequency, how much blood is being cleaned

Albumin, hemoglobin, composite bone and minerals (PTH, Ca, Phos)