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F.
Other Organ Systems
F.6 Renal Disease
Content
Areas
- Sodium
- Potassium
- Calcium
- Phosphorous
- Fluid
and electrolytes
- Acute
renal failure
- Chronic
renal failure (pre-dialysis)
- Dialysis
- Renal
Transplantation
- Nephrotic
Syndrome
- Nephrolithiasis
- Herbal
supplement-nutrient/drug interactions
- Dyslipidemia
or (hyperlipidemia)
- Medical
nutrition therapy
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After
training, the learner will be able to:
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| Knowledge
Objectives: Medical Students |
- Describe
the nutritional, metabolic, and clinical consequences of
chronic renal failure.
- Explain
the interrelationships of renal disease and dietary factors
such as protein, sodium, potassium, calcium, magnesium,
phosphorus, and water; identify which patients need to restrict
these nutrients.
- List
the three most useful laboratory tests used to recognize
nutritional causes and consequences of renal impairment.
- Explain
how protein restriction or other changes in the nutrient
composition of the diet can alter the progression of renal
disease in patients with chronic renal failure.
- List
three common foods that are relatively high in each of the
following: sodium, calcium, potassium, and phosphate; identify
which patients with renal disease need to restrict these
foods.
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| Knowledge
Objectives: Residents |
- Identify
the nutritional deficiencies typically found in patients
with chronic renal failure (CRF); compare and contrast the
nutritional needs of those receiving maintenance hemodialysis
with those receiving continuous ambulatory peritoneal dialysis.
- Identify
the proper modification of dietary sodium, calcium, phosphorus,
protein and fluids for patients with recurrent nephrolithiasis,
and explain how each modification decreases morbidity.
- Compare
and contrast the nutritional goals of therapy for patients
with end-stage renal disease receiving dialysis and those
not receiving dialysis.
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| Knowledge
Objectives: Specialists |
- Identify
the specific lipid abnormalities typically associated with
CRF, renal transplantation, and the nephrotic syndrome and
outline the recommended nutritional regimens for these patients.
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| Practice
Behavior Skills: Medical Students |
- Take
an appropriate medical history, including weight change,
history of renal disease, co-morbid conditions that can
impact renal disease, and use of prescribed
and over-the-counter medications and nutritional supplements.
- Take
an appropriate social and dietary history, including an
assessment of the patient’s exercise patterns.
- Conduct
an appropriate physical examination for a patient with renal
disease, including height and weight; calculate the BMI
and determine the fluid status.
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| Practice
Behavior Skills: Residents |
- Consult
with a registered dietitian as appropriate to provide individualized
dietary counseling based on an assessment of a patient’s
dietary intake, including total calories, protein, total
and saturated fat, sodium, potassium, calcium, phosphorus,
magnesium, and fluid intake.
- Prioritize
dietary guidelines and lifestyle changes for patients with
chronic renal disease or recurrent nephrolithiasis, with
or without other chronic diseases.
- Evaluate
the diet of a patient on dialysis and refer to a registered
dietitian as appropriate.
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| Practice
Behavior Skills: Specialists |
- Evaluate
the diet of a renal transplant patient before and after
surgery, and develop a nutritional plan for the patient
with particular focus on the likely effects of immunosuppressive
therapy.
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| Attitude
Objectives: All Learners |
- Demonstrate
a commitment to utilizing a multi-disciplinary team approach
to the treatment of renal disease, consulting with registered
dietitians, clinical psychologists/behavioral medicine specialists,
nurse practitioners, physician assistants, and clinical
pharmacists as appropriate.
- Demonstrate
a commitment to promote appropriate nutrition and lifestyle
modifications for patients with acute or chronic renal disease,
nephrotic syndrome, or nephrolithiasis.
- Recognize
the importance of healthy lifestyle behaviors in the treatment
and management of renal disease.
- Demonstrate
an awareness of the impact of co-morbid conditions of patients
with renal diseases that may influence compliance with recommended
changes in diet and lifestyle.
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