1 / 23

Medical Nutrition Therapy for Nephrolithiasis

Medical Nutrition Therapy for Nephrolithiasis. Tara J. Ray Concordia College Moorhead, MN. Objectives . Describe the condition of Nephrolithiasis Determine how to assess a patient with Nephrolithiasis Identify risk factors contributing to development of Nephrolithiasis

reba
Download Presentation

Medical Nutrition Therapy for Nephrolithiasis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Medical Nutrition Therapy for Nephrolithiasis Tara J. Ray Concordia College Moorhead, MN

  2. Objectives • Describe the condition of Nephrolithiasis • Determine how to assess a patient with Nephrolithiasis • Identify risk factors contributing to development of Nephrolithiasis • Understand medical nutrition therapy for Nephrolithiasis

  3. Definition • What is Nephrolithiasis? • Also known as “Kidney Stones” • Kidney Stones are solid crystalline masses formed in the kidney that must pass through the urinary tract Nelms, Marcia, Sucher, Kathryn & Long, Sara. (2007). Nutrition Therapy and Pathophysiology. Belmont: Thomson.

  4. Prevalence • Nephrolithiasis affects over 5% of adults in the United States • 12% men • 6% women • 50% of patients will have additional stones Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110. Worcester, Elaine M. & Coe, Fredric L. (2008). Nephrolithiasis. Prim Care; 35(2), 369–vii. Retrieved September 9, 2009, from Pub Med database.

  5. Signs and Symptoms • Hematuria • Nausea and vomiting • Pain with urination • Urgency to urinate • Lower flank pain Nelms, Marcia, Sucher, Kathryn & Long, Sara. (2007). Nutrition Therapy and Pathophysiology. Belmont: Thomson.

  6. Assessment and Analysis • GOLD STANDARD for detection of stones • Computerized Tomography (CT) scan • If stone is captured • Crystallographic analysis techniques • Type of stone is determined • Assess dietary habits • Quantify number of stones and duration of stone disease • Single Stone • Serum electrolytes, creatinine , calcium • Multiple/Recurring Stones • 24-hour urine screening Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.

  7. Types of Stones • Calcium Oxalate (CaOx) • Uric Acid (UA) • Magnesium Ammonium Phosphate • Calcium Phosphate • Struvite • Cystine • Carbon Apatite Worcester, Elaine M., Parks, Joan H., Evan, Andrew P. & Coe, Fredric L. (2006). Renal Function in Patients with Nephrolithiasis. Journal of Urology, 176, 600-603.

  8. Pathophysiology • Urine calcium concentration determines level of supersaturation • Both high and low levels of calcium can be a risk • Supersaturation can predict type of stone • Hypercalciuria – most common metabolic abnormality • > 300 mg/day men • > 250 mg/day women • Hyperoxaluria – 30% Nephrolithaisis patients • > 90 mg/day • Hypocitrauria • < 325 mg/day Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110. Worcester, Elaine M. & Coe, Fredric L. (2008). Nephrolithiasis. Prim Care; 35(2), 369–vii. Retrieved September 9, 2009, from Pub Med database.

  9. Pathophysiology • Hyperuricosuria – 10-25% Nephrolithaisis patients • Urine pH • Increased urine pH (more basic) leads to calcium phosphate stones • Decreased urine pH (more acidic) leads to uric acid stones • Volume • High fluid intake reduces stone reoccurrence • Electrolytes • Magnesium Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110.

  10. Risk Factors • Increased BMI • Increased waist circumference • Genetics • Hypertension • Hypercalciuria • Vitamin C • Diarrheal state Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110. Moe, Orson W., Abate, Nicola & Sakhaee, Khashayar. (2002). Pathophysiology of uric acid nephrolithiasis. Endocrinol Metab Clin N Am, 31, 895-914. Worcester, Elaine M. & Coe, Fredric L. (2008). Nephrolithiasis. Prim Care; 35(2), 369–vii. Retrieved September 9, 2009, from Pub Med database. Worcester, Elaine M., Parks, Joan H., Evan, Andrew P. & Coe, Fredric L. (2006). Renal Function in Patients with Nephrolithiasis. Journal of Urology, 176, 600-603.

  11. Risk Factors • Urinary Tract Infection • Catheterization • Bowel Disease • Environmental Factors: • Heat exposure • Employment • Exercise Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110. Moe, Orson W., Abate, Nicola & Sakhaee, Khashayar. (2002). Pathophysiology of uric acid nephrolithiasis. Endocrinol Metab Clin N Am, 31, 895-914.

  12. Research Studies • Retrospective, prospective, epidemiologic and population based studies all concluded Nephrolithiasis corresponds with body mass and diabetes based on increased incidence in all cases • DKD – Diabetic Kidney Disease • American Dietetic Association Evidenced Based Library • Randomized control study trail with diabetic subjects • Nurse’s Health Study • Healthy portions of protein from: fish, poultry, soy, dairy Moe, Orson W., Abate, Nicola & Sakhaee, Khashayar. (2002). Pathophysiology of uric acid nephrolithiasis. Endocrinol Metab Clin N Am, 31, 895-914.

  13. Research Studies • Population based study in Olmsted, MN • Tested hypothesis that diabetes mellitus prevalence is increased in people who develop renal stones • Those diagnosed with Nephrolithiasis tended to have high BMI and show signs of hypertension • Uric Acid stone were shown to be most common • Results: • Calcium Oxalate stones in 93 persons 76% • Calcium Phosphate stones in 19 persons 16% • Uric Acid stones in 10 persons 8% Lieske, John C., Pena de ka Vega, Lourdes S., Gettman, Matthew T., Slezak, Jeffrey M., Bergstralh, Eric J., Melton, L. Joseph & Leibson, Cynthia L. (2006). Diabetes Mellitus and the Risk of Urinary Tract Stones: A Population-Based Case-Control Study, American Journal of Kidney Disease. 48, 897-904.

  14. Research Studies • The American Journal of Hypertension • Positive association of hypertension and Nephrolithiasis • 60 men with confirmed cases of Nephrolithiasis • 77 men with confirmed cases of hypertension and risk of stroke • Cross sectional analysis • Men with history of Nephrolithiasis were 29% more likely to report cases of hypertension • Men with hypertension were not likely to develop Nephrolithiasis Madore, Francois, Stampfer, Meir J., Rimm, & Eric B., Curham, Gary C. (1998). Nephrolithiasis and Risk of Hypertension. American Journal of Hypertension, 11, 46-53.

  15. Medical Nutrition Therapy • The goal of MNT for Nephrolithiasis is to prevent new stone formation and prevent preexisting stones from growing Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110. Worcester, Elaine M., Parks, Joan H., Evan, Andrew P. & Coe, Fredric L. (2006). Renal Function in Patients with Nephrolithiasis. Journal of Urology, 176, 600-603.

  16. Medical Nutrition Therapy • Diet used as preventative therapy should be considered • Restriction of calories is relatively safe • Inexpensive compared to medication • Improved glucose tolerance and cardiovascular benefits • Weight Watchers • Reduce calorie intake • Well rounded menu with an infrastructure that makes it appealing to many • DASH Diet • Encourages fruits, whole grain, vegetables, low fat dairy, poultry, fish, nuts • Limited fats, red meats, sodium Goldfarb, David S. (2009). Prospects for Dietary Therapy of Recurrent Nephrolithiasis. Advances in Chronic Kidney Disease, 16, 21-29.

  17. Medical Nutrition Therapy • Decrease sodium to 100 mmol/day • To prevent Calcium containing stones • Decrease excessive animal protein • To prevent Uric acid and calcium stones • > 1 g/kg should be avoided • Recommendation 1 g/kg • .6 g/kg for diabetic patients Avoid grapefruit juice, beets, cola, chocolate, coffee, tea, berries, spinach, and rhubarb Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110. Nelms, Marcia, Sucher, Kathryn & Long, Sara. (2007). Nutrition Therapy and Pathophysiology. Belmont: Thomson. Vergili, Joyce M. (2009). Diabetic Kidney Diesase: What RDs need to know. Today’s Dietitian, 11, 8-48. Worcester, Elaine M. & Coe, Fredric L. (2008). Nephrolithiasis. Prim Care; 35(2), 369–vii. Retrieved September 9, 2009, from Pub Med database.

  18. Medical Nutrition Therapy • Increase calcium intake to 1000 -1200 mg/day *** • Increase fluids with at least 50% WATER • 2.5-3 L/day • Urine volume should be 2 L/day • < 50 mg/day dietary oxalate • To prevent Calcium Oxalate stones • Increase fruits and vegetables • Increase insoluble fiber • Weight loss • Low fat, low calorie Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110. Goldfarb, David S. (2009). Prospects for Dietary Therapy of Recurrent Nephrolithiasis. Advances in Chronic Kidney Disease, 16, 21-29.

  19. Medications • Thiazides • Relatively easy alternative to diet, more simple to comply with • Chlorthialidone • Hydrochlorothiazide • Indapamide • Vitamins and supplements • Avoid calcium supplements • Pharmaceutical companies develop oral preparations to degrade oxalate in the intestinal lumen • Altu-237 • Oxazyme Asplin, John R. (2008). Evaluation of a Kidney Stone Patient. Seminars in Nephrology, 28, 99-110. Goldfarb, David S. (2009). Prospects for Dietary Therapy of Recurrent Nephrolithiasis. Advances in Chronic Kidney Disease, 16, 21-29. Worcester, Elaine M. & Coe, Fredric L. (2008). Nephrolithiasis. Prim Care; 35(2), 369–vii. Retrieved September 9, 2009, from Pub Med database.

  20. Ethics • Children • Pharmaceutical testing Goldfarb, David S. (2009). Prospects for Dietary Therapy of Recurrent Nephrolithiasis. Advances in Chronic Kidney Disease, 16, 21-29. Worcester, Elaine M. & Coe, Fredric L. (2008). Nephrolithiasis. Prim Care; 35(2), 369–vii. Retrieved September 9, 2009, from Pub Med database.

  21. Conclusion • Nephrolithiasis is the condition of crystals forming in the urinary tract from buildup of waste products in the bloodstream filtered by the kidneys • Determining the type of stone is crucial for dietary treatment • Drinking water is the most important thing a person can do to prevent kidney stones

  22. Questions?

More Related