A Case Study on Chronic Kidney Disease with UTI

Submitted to

Ms. Eden Elisan, RND, MPH

Dietary Food Service Department

Adventist Center Manila

In Partial fulfillment

Of the Requirements for the Course

Clinical Internship

Submitted By:

Melarnie June A. Jacinto

March 30, 2017

C. PERTINENT NUTRITION ASSESSMENT DATA

1. ANTHROPOMETRIC DATA
Height: 52
Weight: 55 kg/121 lbs.
Desirable body weight (DBW): 51 kg/114 lbs.
Body Mass Index (BMI): 22 (Normal)

2. BIOCHEMICAL DATA
Interpretation Results Normal Value
Albumin Low 25.9 35-50 g/L
Creatinine High 358 62-106 umol/L
Potassium - 4.4 3.6-5.0 mmol/L
Sodium Low 134 137-145 mmol/L
RBC Low 3.31 4.50-5.40

3. CLINICAL DATA
Blood Pressure 160/100
Heart Rate 91
Temperature 36.3 C

4. DIETARY DATA

Diet Rx:
Low Salt

Food Preferences:
Fish (tuyo/fried)
Soft drinks
Chips & Street foods
Only little vegetables (whenever available)
 A. NUTRITION DIAGNOSIS
P: kidney problem
E: as related to high consumption of salty foods
S: as evidenced by high creatinine levels

P: anemia
E: as related to chronic kidney disease
S: as evidenced by low laboratory results of RBC

B. NUTRITION CARE PLAN

TOTAL CALORIE PROVISION 1,800 KCAL/DAY

CHO 1,800 x 0.60 / 4 = 270

CHON 1,800 x 0.15 / 4 = 65
FAT 1,800 x 0.25 / 9 = 50

TOTAL PROTEIN PROVISION 50 G/DAY

CHO: 270 G/DAY
FAT: 50 G/DAY

FOOD EXCHANGE LIST

Food Group No. of CHO (g) CHON (g) FAT (g) ENERGY
Exchanges (Kcal)
Vegetable A 8 12 4 - 64
Vegetable B 4 12 4 - 64

Fruit 3 30 - - 120

Milk 1 12 8 5 125
Sugar 1 5 - - 20

Rice 8 184 16 - 800

Meat 5 - 40 30 430

Fat 3 - - 15 135
255 70 50 1,783

CHO 270-71 = 199 / 23 = 8

CHON 70-32 = 38 / 8 = 5
FAT 50-35 = 15 / 5 = 3
Food item Na K Ca P
 Malunggay 4 240 80 30
Ampalaya 2 120 40 15
Singkamas 2 0.6 15 15
Cabbage 8 110 30 10
Cucumber 4 1.2 30 30
Carrot 8 110 30 10
Chayote 2 0.6 15 15
Togue 4 1.2 30 30
Mango 3 120 10 10
Cranberry juice 15 190 0 0.2
Dalanghita 3 120 10 10
Soymilk 51 0 67 0
Brown rice 2 60 15 35
Oatmeal 0 150 0.2 0.15
Whole wheat bread 230 60 20 35
Tofu 70 200 120 135
Egg 110 95 50 115
TOTAL 518 1578.6 562.2 495.35

Food Item Cholesterol Sat. Fat MUFA PUFA

Tofu - 0.39g 0.59g 1.5g
Soymilk - 0.4g 0.5g 1.1g
Egg 275mg 1.6g 2.2g 0.40g
Chickpeas - 0.04g 0.02g 0.15g
TOTAL 275 2.43 3.31 3.15

ONE DAY MEAL PLAN

Breakfast Snack Lunch Snack Supper

Malunggay Pan de sal Suteed Ice drop Salad:
(1 cup) (3 pcs.) Vegetables: (1/4 pc) Cabbage
Ampalaya Chickpea Carrot ( cup) (1 cup)
( cup) spread (1/2 cup) Chayote Water Cucumber
Tofu (1 cup) ( cup) (1 cup)
Water Togue ( cup) Singkamas
Mango (1 sl.) Egg (2 pcs.) (1 cup)

Oatmeal (1 cup) Dalanghita Cranberry Juice

(1 pc) (1 cup)
Soymilk (1 cup)
Brown Rice Bread (2 sl.)
(1 cup)
 C. DIET PRESCRIPTION
Low fat
Low salt
High Iron
High vitamin C
More Liquids

D. MONITORING

Monitoring
The patient will be given a guide in food
low in fat and salt and foods high in iron
and vitamin C.
Patient will record a daily food intake.
Weekly Anthropometric measurement to
monitor weight changes and nutritional
status.
Evaluation
If patient reached the required
Creatinine values.
If patient has increase RBC,
Hemoglobin and Hematocrit.

E. JOURNAL

Hypokalemia, Its Contributing Factors and Renal Outcomes in Patients with

Chronic Kidney Disease

Wang, Hsiao-Han et. al. (2013)

Abstract

In chronic kidney disease (CKD) the impact of serum potassium (sK) has been
controversial. A study was conducted with 2,500 participants with CKD stage 14
in the Integrated CKD. Observational study were analyzed and followed up for
2.7 years. sK was classified into five groups with the cutpoints of 3.5, 4, 4.5 and 5
mEq/L. Cox proportional hazard regression models predicting the outcomes were
used.

Results

The results show that the mean average age is 62.4 years, mean sK level was
4.20.5 mEq/L and average eGFR was 40.6 ml/min per 1.73 m2. Female vs male,
diuretic use vs. non-use, hypertension, higher Glomerular Filtration Rate (eGFR),
bicarbonate, CRP and hemoglobin levels significantly correlated with low
potassium (hypokalemia). In patients with lower sK, nephrotic range proteinuria,
and hypoalbuminemia were more prevalent but the use of RAS (renin-angiotensin
 system) inhibitors was less frequent. Hypokalemia was significantly associated
with end stage renal disease (ESRD) and was also associated with rapid decline of
renal function defined as eGFR slope below 20% of the distribution range.

Conclusion

In conclusion, both hypokalemia and hyperkalemia are associated with increased

risk of ESRD in CKD population. Hypokalemia is related to increased use of
diuretics, decreased use of RAS blockade and malnutrition, all of which may
impose additive deleterious effects on renal outcomes.

F. Glossary

Anemia a condition in which the oxygen-carrying capacity of blood reduced.

Creatinine a chemical waste product in the blood that passes through the
kidneys to be filtered and eliminated in urine.
CKD - Chronic kidney disease, a condition characterized by a gradual loss of
kidney function over time.
End-stage renal disease - your kidneys are functioning below 10 percent of their
normal function.
Erythropoietin - a hormone secreted by the kidneys that increases the rate of
production of red blood cells in response to falling levels of oxygen in the tissues.
Glomerular filtration rate (GFR) - the amount of filtered formed in all the
renal corpuscles of both kidneys each minute.
Hypokalemia Low potassium level
Hyperkalemia High potassium level
Hypoalbuminemia Low albumin level