Nutritional Aspects of Urogenital Diseases
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Transcript of Nutritional Aspects of Urogenital Diseases
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NUTRITIONAL ASPECTS
OF UROGENITAL
DISEASES
ARYANTI R. BAMAHRY
FK-UMI
2015
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Kidney Function
Bone Structure
Bone Structure
Vitamin DActivation
CalciumBalance
Blood Formation
Blood Formation
ErythropoietinSynthesis
Cardiac Activity
Cardiac Activity
PotassiumBalance
Regulation of Blood p
Regulation of Blood p
Recovery ofBicar!onateBlood Pressure
Blood Pressure
"ater Balance
SodiumRemoval
#eta!olicEnd Products
#eta!olicEnd Products
Removal of
$rea% Creatinine etc&
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UROGENITAL DISEASES
Acute nephritis
Nephrotic syndrome
Asymptomatic urinary abnormalities
Acute renal failureChronic kidney disease
Urinary tract infection
Urinary tract obstruction
NephrolithiasisHypertension
Renal tubular defects
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THE ROLE OF NUTRITIONAL
SUPPORT IN KIDNEY DISEASE
' (o prevent or reverse associated
malnourished states&
' (o minimi)e the adverse effect ofsu!stances that are inade*uately
e+creted&
' Favora!ly affect the progression andoutcome of ,idney disease&
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NUTRITION SUPPORT IN
KIDNEY DISEASE
Energy
- 25-40 kcalkg!"d
- to a#oid $eight loss%rotein
- Renal diseaseproteinuria
- Uremia
restricting protein intake
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&ipids
- Aggressi#ely lo$ering lipids profile '()
*luids and electrolytes -"ater '500-+00 ml ,Urine utput)
- .odium '/-gday)
- %otassiumHyperkalemia'1)
- %hosporus calsium magnesium
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3itamins- poor oral intake
- decrease renal reabsorption
- losses from dialysisrace elements
- iron deficiency 'poor oral intakeintestinal
absorption
ERR%6E67
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NEPHROTIC SYNDROME
An a!normal condition that is mar,ed !y deficiency of
al!umin in the !lood and its e+cretion in the urinedue
to altered permeability of the glomerular basement
membranes&
8&6768A& .9%9. :
' Proteinuria - .&/ g0day
' yperlipidemia
' ypoal!uminemia 12.&/ g0d34
' Edema
' iper,oagula!ility
' 5ligouria 1 2 677cc4
8lomerular Diseases& Kidney arrison&
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NUTRITION THERAPY
;A& :
' #inimi)ing the effects of edema% proteinuria
9 hyperlipidemia&
' Replacing nutrients lost in the urine&
' Reducing the ris,s of further renal
progression and atherosclerosis&
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:utrition therapy and pathophysiology& ;77anti insulin>
H6%ER?AA!&6.9E
8lu,agon
Kate,olamin
8lu,o,orti,oid
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Kata!olisme protein ?
,eseim!angan nitrogen 1@4
Akumulasi toksin uremi6nfeksi
Survival Rate
H6%ER?AA!&6.9E
8angguan =munitas
Daya (ahan tu!uh
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?6@7E
*A6&URE
metabolic
acidosis
oidation in
muscles
!8AAB
#aline B B
leucine Bisoleucine B
defecti#e
phenylalanine
hydroylation
tyrosine B
threonine B
lysine B
serine B
decrease
production
tryptophane B
reduce
protein bindingarginine B
glycine Ccitruline C
cystine C
aspartate C
methionine C
methyl-
histidine C
Essential AA
:on@essential AA
Special AA
9itch "E= Handbook of 7utrition and the ?idney 2005
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' Ada / tidak adanya komplikasi pd ARF
' Kelainan Metabolisme Karbohidrat
' Kelainan Metabolisme Lipid' Kelainan Metabolisme Asam amino
' Metabolisme Mikronutrien
' Metabolisme Trace elements' TPG terapi pengganti gin!al"
%emberian 7utrisi pada AR*
tergantung:
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#nergy $%&'( ma) '%" kkal/kg *+/d
,arbohydrate '&% ma) -" g/kg *+/d
Lipid (.&0.$ ma) 0.%" g/kg *+/d
Protein
,onser1atif therapy (.2&(. ma) 0.(" g/kg *+/d
#)tracorporeal therapy 0.(&0.% g/kg*+/d
3 hyperkatabolism ma) 0.- g/kg *+/d
NUTRITION THERAPY IN ARF(ESPEN, 2011)
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4itamin Re5uirement +ater soluble 1itaminincreased
because of losses associated 6ith renal replacement
therapy7 4it7 *2 0( mg/d. 4it7 , 2(&0(( mg/d"
Fat soluble 1itaminnot lost during renal
replacement therapysupplementation not recommended
#lectrolytes 4ary profoundlymust be determined indi1idually
Many patients ARF 6ith hypokalemia/hypofosfatemia or during
,RRT 6ith lo6 electrolytes solutions7
NUTRITION THERAPY IN ARF(ESPEN, 2011)
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P#8GAR9: T#RAP; P#8GGA8T; G;8
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?TAT9? 89TR;?; PA=A ARF
' Penderita sakit kritis dengan ARFpotensi
kehilangan nutrien
' #1aluasi status nutrisi sulit
perubahan didalam komposisi tubuh
' Protein #nergy +asting P#+"
Fiaccadori% :ephrol ;77;6/@/
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P#8;LA;A8 ?TAT9? 89TR;?;
*iokimia albumin dan prealbumin"
@ berat badan
@ massa otot
@ asupan energi dan protein
.ubDecti#e ;lobalAssessment '.;A)
Fiaccadori% :ephrol ;77;6/@/
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25
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' ?elainan struktur atau fungsi ginDal bulan
dengan atau tanpa penurunan ;*R
berdasarkan :
- kelainan patologis
- petanda kerusakan ginDal 'proteinuria
atau kelainan pada radiologi)=
' ;*R > +0 mlmenit/FmG selama bulandengan atau tanpa kerusakan ginDal=
CHRONIC KIDNEY DISEASE
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CHRONIC KIDNEY DISEASE
&Klasifi,asi CKD !erdasar,an penye!a!% ,ategori 8FR
dan ,ategori al!uminuria&
Kidney Disease =mproving 8lo!al 5utcomes 1KD=854 CKD "or, 8roup& KD=85 ;7; Clinical Practice 8uideline for the
Evaluation and #anagement of Chronic Kidney Disease& ;7.
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CHRONIC KIDNEY DISEASE
&Klasifi,asi CKD !erdasar,an penye!a!% ,ategori 8FR
dan ,ategori al!uminuria&
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R6.? *A8R. :' @iabetes
' Hypertension
' Autoimmune diseases
' .ystemic infections
' Eposure to drugs or procedures associated $ith acute
decline in kidney function
' Reco#ery from acute kidney failure
' Age +0 years
' *amily history of kidney disease
' Reduced kidney mass 'includes kidney donors and
transplant recipients)
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CHRONIC KIDNEY DISEASE
&Klasifi,asi CKD !erdasar,an penye!a!% ,ategori 8FR
dan ,ategori al!uminuria&
Kidney Disease =mproving 8lo!al 5utcomes 1KD=854 CKD "or, 8roup& KD=85 ;7; Clinical Practice 8uideline for the
Evaluation and #anagement of Chronic Kidney Disease& ;7.
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Kidney Disease =mproving 8lo!al 5utcomes 1KD=854 CKD "or, 8roup& KD=85 ;7; Clinical Practice 8uideline for the
Evaluation and #anagement of Chronic Kidney Disease& ;7.
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3ang F& Color Atlas of Pathophysiology ;777
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CLINICAL SYMPTOMS
Edema
Uremia
yperphosphatemia
yper,alemia
#eta!olic acidosis
A
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67@6?AR 9A&7UR6.6 %A@A %A.6E7 8?@
1Pernefri% ;74
. Subjective Global Assessment1B4 dan 1C4
;& Al!umin serum 2 6%7 g0d3.& Kreatinin serum 2 7 mg0d3
6& =nde,s massa tu!uh 2 ;7 ,g0m;
/& Kolesterol 2 6G mg0d3
& Preal!umin serum 2 .77 mg03
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./
OPTIONS - THERAPY OF ESRD
1. CONSERVATIF MANAGEMENT
2. DIALYSISA. HEMODIALISIS
B. PERITONEAL-DIALISIS
. TRANSPLANT
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.
CONSERVATIF MANAGEMENT
1. LIMITATION SYMPTOMS
2. PREVENT IRREVERSIBLE RENAL
DAMAGED
. MAINTAIN OF HEALTH BEFORE
DIALYSIS OR TRANSPLANTASION
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NUTRITION THERAPY
;A& :
' (o prevent malnutrition at an early stage of renal
disease0 maintain optimal nutritional status&
' (o reduce or control accumulation of Haste products&' (o prevent CVD disease !y treating hyperlipidemia%
manage !one disease !y treating vitamin D
deficiensies% and treating hyperparathyroidism&
' (o correct renal anemia to retard progression of renaldysfunction&
Druml "% Cano :% (eplan V& :utritional support in renal disease& =n So!ot,a 3 1eds4&Basics in Clinical :utrition& 6thed& 8alen% ESPE:& ;7
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NUTRITION THERAPY (CKD STAGE -5)
?ebutuhan energi : ./ I 6/ ,,al0,g0hari?ebutuhan lemak :
J .7 energi dari lema,% dengan lema, Lenuh
2 7 total ,alori% ,olesterol 2 .77 mg0hari
?ebutuhan protein :
CKD stage @. 18FR - .7 m30min4 7%G/ g0,gBB=0hari
CKD stage 6@/ tanpa dialisis 18FR - .7 m30min4
7% g0,gBB=0hari&CKD dgn dialisis %; g0,gBB=0hari&
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TU!UAN DIET RENDAH PROTEIN
' (o sloH the progression of ,idney
disease
' #inimi)e accumulation of uremic to+ins
' Preserve protein nutritional status
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@iet rendah protein
Konvensional
Ke!utuhan protein untu, pasien CKD ' Proteinuria 2 %/ g0hari 7% I 7% g0,gBB=0hari&
' Proteinuria -%/ g0hari% seLumlah protein yang
sama harus ditam!ah,an melalui ma,anan&' Protein (High Biologycal Value /7@G/
Supplemented very low-protein (!"#$ diet
Di!eri,an pada CKD tahap lanLut 1CKD stage 6@/4%
dengan keto amino acids7%. I 7%6 g0,g0hari1ESPE:% ;7. 9 :KF% ;7.4
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3ER &" %RE677EE@ ?E A86@ A7A&;UE.
(hese agent are transaminated in the li#er by non essentialamino acids to the correspondingessential amino acids
Hhich are then use for protein synthesis=
he role of ?eto Acid Analogues :& =mprove symptoms
;& #aintains a good nutritional state
.& 3imits proteinuria
6& Can delay the time until renal replacement therapy is
needed&
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.%E86*68 67ER7A67A& ;U6@E&67E.
RE899E7@A67 . *R ?E A86@ HERA%
' 3oH protein diet 17&@7G g0Kg !&H&0dayCr Cl /7
ml0min0&G. m;4
' Keto acid therapy indicated ;7@;/ ml0min0&G. m;4
' 3oH protein diet M,eto acid7&6@7& gr0,g B"0day' Dosage of ,eto acid 7& gr0,g B"0day
' Daily energy inta,e of ./ ,cal0,g B"0dayshould !e
recommended&' Protein calories must !e replaced !y comple+ C
calories@not !y lipid
Am :ephrol ;77/;/1suppl4@;
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MONITORING PROTEIN HOMEOSTASIS
& Based on renal damaged
indicator higher 0 loHer of muscle mass loss
;& Creatinine clearance
8FR renal damaged loH creatinin clearance% creatinineserum Ihigh
.& B$: 1B355D $REA :=(R58E:4 I indicator of renal functionSta!il PR5(E=: D=E(
B$: increased increased PR5(E=: =:(AKE&
Dehidration 0 cata!olic state 1surgery% !urn% infection% fracturedrug cata!olic steroid
3EVE3 7@ 7 mg0dl
ACCEP(AB3E- 7 uremia
2 67 malnutrisi
6& $rea clearance filtration capa!ility
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NUTRITION THERAPY (CKD-HD)
UIUA7 :
' #encegah% mendete,si atau mengatasi
malnutrisi&' #engurangi a,umulasi cairan% sisa meta!olisme%
,alium dan fosfor&
' #encegah ,ompli,asi uremia 1penya,it
,ardiovas,uler dan penya,it tulang4&
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REKOME DASI ASUPA
VITAMI LARUT AIR PADA CKD
7utrien %re-@ialisis Hemodialisis
(hiamine 1B4 @%/ mg0hari %@%; mg0hari
Ri!oflavin 1B;4 @; mg0hari %@%. mg0hari
:iasin (ida, ada 6@ mg0hari
Asam Pantotenat 1B/4 (ida, ada / mg0hari
Pyrido+ine 1B4 / mg0hari 7 mg0hari
Biotin (ida, ada .7 Ng0hari
Asam Folat 1B
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VITAMI LARUT LEMAK PADA
CKD
7utrien %re-@ialisis Hemodialisis
Vitamin A (ida, ada G77@
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REKOME DASI ASUPA MI ERAL
PADA CKD
7utrien %re-@ialisis Hemodialisis:aCl 2 / g0hari /@ g0hari
Kalium .< mg0,g0haritergantung nilaila!oratorium
@G mg0,g0hari
Kalsium ;77 mg0hari J ;777 mg0hari daridiet dan o!at
Fosfor 77@777 mg0hari 1Li,afosfat serum - 6%
mg0d3 dan atau P( -
6%< pg0m34
77@777 mg0hari
Oinc 1On4 (ida, ada i,a perlu
Besi 1Fe4 =ndividual =ndividual
Selenium (ida, ada (ida, ada
Dharmei)ar d,,& Pernefri;7&
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6