Renal Case Study

Case Questions
I. Understanding the Disease and Pathophysiology

Describe the basic physiological functions of the kidneys.

List the diseases/conditions that most commonly lead to chronic kidney disease
(CKD). Explain the role of diabetes in the development of CKD.

Outline the stages of CKD, including the distinguishing signs and symptoms.

From your reading of Mrs. Joaquin’s history and physical, what signs and symptoms
did shehavethatcorrelatewithherchronickidneydisease?

What are the three treatment options for Stage 5 CKD? Explain the differences
between hemodialysisandperitonealdialysis.

II. Understanding the Nutrition Therapy
6. Explain the reasons for the following components of Mrs. Joaquin’s medical nutrition therapy.
35 kcal/kg:
1.2 g protein/kg:
2 g K:
1 g phosphorus:
2 g Na:
1000 mL fluid + urine output:
7. Calculate and interpret Mrs. Joaquin’s BMI. How does edema affect your interpretation?
8. What is edema-free weight? Calculate Mrs. Joaquin’s edema-free weight. (Resource: pg 548
and Table 18.6 for calculation)
9. What are the energy requirements for CKD?
10. Calculate what Mrs. Joaquin’s energy and protein needs will be once she begins
hemodialysis.
11. What are the differences in protein requirements among stages 1 and 2 CKD, stages 3 and 4
CKD, hemodialysis, and peritoneal dialysis patients? What is the rationale for these differences?
12. Mrs. Joaquin has a PO4 restriction. Why? List the foods that have the highest levels of
phosphorus.
13. Mrs. Joaquin tells you that one of her friends can drink only certain amounts of liquids and
wants to know if that is the case for her. What foods are considered to be fluids? What fluid
restriction is generally recommended for someone on hemodialysis? Is there a standard

guideline for maximum fluid gain between dialysis visits? If a patient must follow a fluid
restriction, what can be done to help assure adherence and reduce his or her thirst?
14. Several biochemical indices are used to diagnose chronic kidney disease. One is glomerular
filtration rate (GFR). What does GFR measure? What is a normal GFR? Interpret her value.
15. Evaluate Mrs. Joaquin’s chemistry report. What labs are altered due to her diagnosis of
Stage 5 CKD?
16. Which of Mrs. Joaquin’s symptoms would you expect to begin to improve when she starts
dialysis?
17. The following medications were prescribed for Mrs. Joaquin. Explain why each was
prescribed (the indications/mechanism) and describe any nutritional concerns and dietary
recommendations related to the medication.
Capoten/captopril:
Erythropoietin:
Sodium bicarbonate:
Renal caps:
Renvela:
Hectorol:
Glucophage:
18. List the nutrition-related health problems that have been identified in the Pima Indians
through epidemiological data. Are the Pima at higher risk for complications of diabetes?
Explain. What is meant by the “thrifty gene” theory?
III. Nutrition Diagnosis
19. Choose two high-priority nutrition problems and complete a PES statement for each.
IV. Nutrition Intervention
20. For each PES statement, establish an ideal goal (based on the signs and symptoms) and
appropriate intervention (based on the etiology).
21. Why is it recommended that patients obtain at least 50% of their protein from sources
that
have high biological value?
22. What resources and counseling techniques would you use to teach Mrs. Joaquin about
her diet?
23. A. Based on Mrs. Joaquin’s energy needs, calculate her carbohydrate, protein, and fat
needs. Using the Renal Exchange list, plan a 1-day diet that meets her energy needs
and complies with her diet orders (see question 6).

B. Using Mrs. Joaquin’s typical intake and the prescribed meal plan above, write a sample
menu. Justify your changes; why did you make the change to comply with her nutrition
prescription?

Diet PTA

Sample Menu

Breakfast: Cold cereal (2 c unsweetened)
Bread (2 slices) or fried potatoes
(1 medium potato)
1 fried egg (occasionally)
2 cups coffee

Lunch: Bologna sandwich (2 slices white bread,
2 slices bologna, mustard)
Potato chips (1 oz)
1 can Coke

Dinner: Chili con carne (3 oz beef)
Indian fry bread (1 slice, 6″ diameter)
Iced tea with sugar (16 oz)
HS Snack: Crackers (6 saltines) and peanut
butter (2 tbsp)

24. Write an initial ADIME note for your consultation with Mrs. Joaquin.

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