Nutritional Aspects of Urogenital Diseases

7/26/2019 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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' ?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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&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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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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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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Nutritional Aspects of Urogenital Diseases

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