CSR Risk Assessment & Mitigation 3 — Questions and Answers
Question 1: A renal transplant recipient 6 months post-transplant has a BMI of 31 and fasting glucose of 118 mg/dL. Which post-transplant risk does this clinical picture most suggest?
- Calcineurin inhibitor nephrotoxicity
- New-onset diabetes after transplant (NODAT) (Correct answer)
- Acute rejection triggered by metabolic imbalance
- Hypoglycemia from tacrolimus-induced insulin excess
Correct answer: New-onset diabetes after transplant (NODAT)
Weight gain, hyperglycemia, and the immunosuppressive regimen (especially tacrolimus and corticosteroids) place transplant recipients at high risk for NODAT, which worsens graft outcomes.
Question 2: Which dietary pattern poses the greatest acute hyperkalemia risk for a hemodialysis patient who misses a dialysis session?
- High intake of refined white carbohydrates
- Consumption of salt substitutes containing potassium chloride (Correct answer)
- Excessive fluid intake between sessions
- High-fat meal from fast food sources
Correct answer: Consumption of salt substitutes containing potassium chloride
Salt substitutes replace sodium with potassium chloride and can deliver a large acute potassium load, critically dangerous if a dialysis session is missed.
Question 3: A CKD patient's serum bicarbonate is 18 mEq/L on repeat labs. Which nutritional risk is most directly associated with chronic metabolic acidosis in CKD?
- Increased vitamin D activation and hypercalcemia
- Protein catabolism and accelerated muscle wasting (Correct answer)
- Enhanced intestinal phosphorus absorption
- Hypernatremia from renal bicarbonate retention
Correct answer: Protein catabolism and accelerated muscle wasting
Chronic metabolic acidosis in CKD activates protein catabolism pathways, worsening protein-energy wasting and accelerating muscle loss.
Question 4: A dietitian reviews labs for a CKD patient taking herbal supplements. Elevated serum potassium with no dietary explanation is found. Which supplement class poses the greatest hyperkalemia risk?
- Iron-containing herbal teas
- Aloe vera and dandelion root (Correct answer)
- Licorice root and star anise
- Echinacea and St. John's Wort
Correct answer: Aloe vera and dandelion root
Aloe vera and dandelion are naturally high in potassium and are commonly used herbal remedies that significantly raise potassium intake in CKD patients.
Question 5: Which anthropometric measurement is considered most reliable for assessing body composition and nutritional risk in ESRD patients who have significant fluid overload?
- BMI calculated from current body weight
- Bioelectrical impedance analysis (BIA) performed post-dialysis (Correct answer)
- Mid-arm circumference measured at any time
- Waist circumference taken pre-dialysis
Correct answer: Bioelectrical impedance analysis (BIA) performed post-dialysis
BIA performed immediately post-dialysis provides the most accurate body composition data because fluid status is closest to dry weight, minimizing hydration interference.
Question 6: A patient with nephrotic syndrome and serum albumin of 2.1 g/dL is at elevated risk for which specific nutritional complication?
- Hypervitaminosis A from reduced renal clearance
- Fat-soluble vitamin and zinc deficiency due to urinary protein losses (Correct answer)
- Vitamin B12 toxicity from impaired renal excretion
- Water-soluble vitamin toxicity
Correct answer: Fat-soluble vitamin and zinc deficiency due to urinary protein losses
Nephrotic syndrome causes massive urinary losses of carrier proteins, leading to deficiencies in zinc, copper, and fat-soluble vitamins like vitamin D that are protein-bound.
Question 7: When identifying nutritional risk in CKD patients, which combination of lab values is most consistent with protein-energy wasting (PEW)?
- High albumin, high creatinine, high BUN
- Low albumin, low prealbumin, low serum creatinine (Correct answer)
- Low albumin, high phosphorus, high potassium
- Normal albumin, high BUN, low bicarbonate
Correct answer: Low albumin, low prealbumin, low serum creatinine
PEW is characterized by low albumin, low prealbumin, and paradoxically low serum creatinine due to reduced muscle mass and protein intake in CKD.
CSR Risk Assessment & Mitigation 3
A renal transplant recipient 6 months post-transplant has a BMI of 31 and fasting glucose of 118 mg/dL.
Which post-transplant risk does this clinical picture most suggest?