By William E.; Klahr, SAulo Mitch
Completely revised and up-to-date for its 5th version, this guide is a pragmatic, simply obtainable consultant to dietary administration of sufferers with kidney problems. major foreign specialists current state of the art details on those sufferers' dietary necessities and supply nutritional suggestions, with menus and lists of supplementations to reinforce sufferer compliance. quite a few tables and figures allow readers to discover crucial info speedy. Six of this edition's chapters have new contributing authors. assurance comprises new info on dietary administration of lipid problems and abnormalities in calcium, phosphorus, and bone metabolism. Chapters on dietary specifications in hemodialysis and peritoneal dialysis were thoroughly up to date.
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Additional resources for Handbook of Nutrition and the Kidney 5th Edition
Sample text
DISORDERS OF CARBOHYDRATE METABOLISM IN RENAL INSUFFICIENCY Patients with renal insufficiency have a certain degree of glucose intolerance. Although most patients with renal insufficiency are euglycemic when fasting, some evidence indicates that glucose intolerance occurs after oral or intravenous glucose loads. 39 The abnormal glucose metabolism of patients with renal insufficiency is characterized by fasting euglycemia, abnormal glucose tolerance, a delayed decrease in blood glucose in response to insulin, hyperinsulinemia, and hyperglucagonemia (see Table 2-3).
In experimental animals, nephrectomy prolongs the plasma half-life of insulin, proinsulin, glucagon, PTH, growth hormones, and others. Consequently, the circulating levels of numerous peptide hormones are elevated in advanced renal insufficiency (see Table 2-2). In most instances, successful renal transplantation rapidly returns the circulating levels of many peptide hormones to normal levels. Table 2-2. 32 Insulin, Proinsulin, and C-Peptide The major sites of insulin degradation are the kidney and the liver.
Endothelin The plasma levels and urinary excretion of endothelin-1, a potent endogenous vasoconstrictor peptide, are higher in patients with renal insufficiency than in healthy subjects and correlate with the degree of renal impairment. Both the hypertension present in CKD and that occurring with EPO administration have been attributed to endothelin-1-mediated responses. Catecholamines Plasma levels of norepinephrine are within normal limits in patients with mild to moderate renal insufficiency, but high levels are found in patients with advanced renal insufficiency.