CSR Case Analysis & Practical Application 3

Question 1

A transplant recipient 6 months post-transplant on tacrolimus and prednisone develops new-onset hyperglycemia and a 15 lb weight gain. Which nutrition counseling priority is MOST appropriate?

Accepted Answer

Provide a calorie-controlled, low glycemic index diet and monitor for post-transplant diabetes

Answer

Calorie-controlled, low glycemic index eating patterns help manage post-transplant diabetes mellitus (PTDM), a common complication of immunosuppressive therapy.

Question 2

A 70-year-old male CKD Stage 5 patient not on dialysis (conservative management) has a serum albumin of 2.8 g/dL. His family requests aggressive nutritional support. What should the dietitian consider FIRST?

Accepted Answer

Assess whether the low albumin reflects inflammation/illness rather than dietary deficiency alone

Answer

Hypoalbuminemia in CKD is often an acute-phase reactant response to inflammation rather than pure protein malnutrition, and aggressive protein loading may not correct it.

Question 3

A hemodialysis patient presents with bone pain, elevated alkaline phosphatase, and a calcium-phosphorus product of 72 mg²/dL². His PTH is 850 pg/mL. Which dietary intervention is MOST critical?

Accepted Answer

Aggressively restrict dietary phosphorus and review phosphate binder adherence

Answer

Persistent hyperphosphatemia drives secondary hyperparathyroidism; dietary phosphorus restriction and binder optimization are first-line nutritional interventions.

Question 4

A PD patient reports frequent episodes of exit site infections and peritonitis. Her serum prealbumin is 14 mg/dL. How does nutritional status relate to her infection risk?

Accepted Answer

Malnutrition impairs immune function, increasing susceptibility to peritonitis and exit site infections

Answer

Protein-energy malnutrition impairs immune function in PD patients, increasing vulnerability to infection, and improving nutritional status is an important adjunct to infection prevention.

Question 5

A renal dietitian reviews labs for a hemodialysis patient whose Kt/V is 1.1 (target ≥1.2) and nPCR is 0.7 g/kg/day. What does this combination most likely suggest?

Accepted Answer

Possible underdialysis contributing to anorexia and reduced dietary protein intake

Answer

A low Kt/V combined with low nPCR suggests inadequate dialysis dose may be suppressing appetite and contributing to poor protein intake.

(CSR) Board Certified Specialist in Renal Nutrition Practice Test

(CSR) Board Certified Specialist in Renal Nutrition Practice Test

CSR Case Analysis & Practical Application 3